It Happened Again

I don\’t want to sound like a whiner. I hate it when doctors seem like malcontents, complaining when their income is much greater than the national average. I am very lucky to be doing what I do.
But sometimes it can be exasperating. It infuriates me to be subjected to a system where quality is rewarded with less pay; where doctors are motivated to not communicate or cooperate. Especially when my patients pay the price.

\"3_63_kryptonite1\" I am not psychic. I cannot know what happened in a three month hospitalization by placing my hands on a patients head and reading their brain waves. My staff can\’t know that a \”hospital follow-up\” visit is really a major dump because a patient\’s \”insurance ran out\”. I don\’t have the supernatural ability to slow time down so that I can decode the crying of a spouse and confusion of a sick patient and put together a good plan in fifteen minutes. I am not a faith healer. I have no crystal ball. I lost my magic wand. The kryptonite has sucked out my power.

I am funny this way. I like to be called on the phone, not read Tarot cards. I want to know what is going on. Discharge summaries are better for me than tea leaves.

\"crystal Yet somehow the impossible is expected of me. I am expected to pull the rabbit out of the hat – and do so with a smile of appreciation of what a great job I have. But I don\’t smile; I get angry. It is not fun; it stinks.

As much as it stinks for me, however, it is far worse for the patient. I can go home and complain about my day, but the patient has to survive when the system lets them down. The patient\’s family has to live in fear when nobody can tell them what to do. Doctors get frustrated, but patients get sick and die.

And that makes me furious.

22 thoughts on “It Happened Again”

  1. Dr. Rob,
    Such an easy solution to your woes. Of course you’re not a psychic.

    But the nice people answering the psychic hotline are. I forget the number, but if next time you’re lying awake at 3 am I’m sure you’ll see it on the TV.

    Pfft. Do you really think that you have to be able to do everything?

    Smak

  2. Dr. Rob,
    Such an easy solution to your woes. Of course you’re not a psychic.

    But the nice people answering the psychic hotline are. I forget the number, but if next time you’re lying awake at 3 am I’m sure you’ll see it on the TV.

    Pfft. Do you really think that you have to be able to do everything?

    Smak

  3. Wow, a patient was discharged because his health insurance ran out, and the people who sent him out had clear consciences because the patient would follow up with his PCP (you). AND to top it all off, they didn’t send you any information about the patient’s inpatient stay. Of course you’re mad – I feel for the patient. This non-system is so bad… šŸ™ Hang in there, Rob. At least this patient has fallen into the arms of a doctor who cares.

  4. I’m sorry you had a bad day yesterday Dr. Rob. I have to go on a field trip with forty kindergartners to the Zoo today, so it may be me later… I hope today is better, though one day won’t do anything to change the health care delivery system, I know.

  5. I’m sorry you had a bad day yesterday Dr. Rob. I have to go on a field trip with forty kindergartners to the Zoo today, so it may be me later… I hope today is better, though one day won’t do anything to change the health care delivery system, I know.

  6. Wow, a patient was discharged because his health insurance ran out, and the people who sent him out had clear consciences because the patient would follow up with his PCP (you). AND to top it all off, they didn’t send you any information about the patient’s inpatient stay. Of course you’re mad – I feel for the patient. This non-system is so bad… šŸ™ Hang in there, Rob. At least this patient has fallen into the arms of a doctor who cares.

  7. I get where you’re coming from, but you still get the same one hand not talking to the other issues under a supposedly integrated and generally pretty good public healthcare system like we have in the UK.

  8. I get where you’re coming from, but you still get the same one hand not talking to the other issues under a supposedly integrated and generally pretty good public healthcare system like we have in the UK.

  9. One would think that situations like this would no longer be a factor in this day and age of instant communication.

  10. One would think that situations like this would no longer be a factor in this day and age of instant communication.

  11. I’m with Neumed on that spam blocker. It’s difficult to read at times, but you might not be able to do anything about it.
    It is so frustrating on both the patient’s end and yours. My doctor has to constantly ask me what the other doctor said. He gets like you – just plained ticked some days. He doesn’t have time to decode someone else’s take. The hospitals and specialists need to let the PCP know their findings, themselves.

  12. I’m with Neumed on that spam blocker. It’s difficult to read at times, but you might not be able to do anything about it.
    It is so frustrating on both the patient’s end and yours. My doctor has to constantly ask me what the other doctor said. He gets like you – just plained ticked some days. He doesn’t have time to decode someone else’s take. The hospitals and specialists need to let the PCP know their findings, themselves.

  13. By the way, I do realize if you can’t read the spam blocker, you can listen to what your supposed to type in. Still….

  14. By the way, I do realize if you can’t read the spam blocker, you can listen to what your supposed to type in. Still….

  15. This is merely reason #297 that I didn’t go into private pediatrics. Also, only caring for newborns allows me the luxury of not having to worry about the patients past medical history. I do have to know about the mother’s though and often run into issues with poor communication between the obstetricians and our team. If we didn’t search the mother’s chart we would often miss important medical concerns that impact the management of the baby. But your problem is much nastier than that, and likely harder to rectify, which makes mine all the more annoying (to me) because the solution is so darn simple.

  16. This is merely reason #297 that I didn’t go into private pediatrics. Also, only caring for newborns allows me the luxury of not having to worry about the patients past medical history. I do have to know about the mother’s though and often run into issues with poor communication between the obstetricians and our team. If we didn’t search the mother’s chart we would often miss important medical concerns that impact the management of the baby. But your problem is much nastier than that, and likely harder to rectify, which makes mine all the more annoying (to me) because the solution is so darn simple.

  17. I know it doesn’t help anything for you guys in the US PHS, but as I said earlier, you honestly do get the same issues under the UK’s much more integrated system. I think the real answer is for the hospital doctors to stop pretending that they’re better than PHC doctors, and actually give you a decent report, and copy films if applicable, on all tests and discharges.

  18. I know it doesn’t help anything for you guys in the US PHS, but as I said earlier, you honestly do get the same issues under the UK’s much more integrated system. I think the real answer is for the hospital doctors to stop pretending that they’re better than PHC doctors, and actually give you a decent report, and copy films if applicable, on all tests and discharges.

  19. Hey Dr. Rob,
    So, I don’t really get what is up on this post, but gather from the comments that the doctors do…
    when my kid was seeing a bazillion specialists and hospitalized, we told EVERY single doctor and their nurse and their social workers to send all info to our primary care pediatrician. Over and over again because a) he is good b) we know and trust HIM c) nobody else was around to synthesize all of the weird specialist tests and reports…

    and guess what? Nobody told him ANYTHING. Nope. Nothing forwarded, he had to log in to read stuff but their medical records computer systems (between hospital and specialty clinics and HMO) weren’t compatible and he couldn’t get all of the reports, yadda yadda.

    Y’all oughtta use ONE system with one login. Or have one primary “database” for medical records.

    ps physician hierarchy is screwball. EVERYONE seemed intimidated by the neurosurgeon — sorry, but as a parent our HMO pediatrician is WAY more important

    hugs and thanx for blogging and kudos to all primary care docs!

  20. Hey Dr. Rob,
    So, I don’t really get what is up on this post, but gather from the comments that the doctors do…
    when my kid was seeing a bazillion specialists and hospitalized, we told EVERY single doctor and their nurse and their social workers to send all info to our primary care pediatrician. Over and over again because a) he is good b) we know and trust HIM c) nobody else was around to synthesize all of the weird specialist tests and reports…

    and guess what? Nobody told him ANYTHING. Nope. Nothing forwarded, he had to log in to read stuff but their medical records computer systems (between hospital and specialty clinics and HMO) weren’t compatible and he couldn’t get all of the reports, yadda yadda.

    Y’all oughtta use ONE system with one login. Or have one primary “database” for medical records.

    ps physician hierarchy is screwball. EVERYONE seemed intimidated by the neurosurgeon — sorry, but as a parent our HMO pediatrician is WAY more important

    hugs and thanx for blogging and kudos to all primary care docs!

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