The Leg.

"I was really sorry to have to call you this morning to tell you that your mother passed away.  I know we all expected this, but I'm sure it's still very difficult."

"Yeah, sure, do you want her leg?"

"I'm sorry, what?"

"Her leg.  The prosthesis.  We were thinking we'd donate it, if you guys want it."

"I mean... it was fit directly to your mother... I'll have to ask someone else if there's any use for a used prosthesis...."

"Do you have a form so we can get a tax deduction for it?"

"I don't have a form, no."

"It's probably still worth almost as much as it was new, right?  Do you know what she would have paid for it if not for the insurance?"

"No."

"Do you think you could find that out?"

"Uh...."

"We also thought we'd donate her walker, if that has any value."

"We could probably use the walker for patients who don't yet have their own...."

"Great, can the hospital pay us anything for that?"

"No...."

"And we pre-paid for another week of television service.  How does that work?  Do you give us back that money, or are we allowed to take the TV for a week?"

"I'm pretty sure you can't take the TV.  You can ask the billing office about getting the money back."

"Great, great.  Do people get buried with their teeth, or do you guys want those too?"

"We don't need her teeth."

"But could we get a tax deduction if we leave them here?"

"I don't think that's something we usually deal with...."

"Is she still getting lunch?  Because we're kind of hungry, and I guess we could all split it if it's going to come anyway."

"No, they stop serving meals after a patient dies."

"Okay, well, just in case they've already set up the tray-- we'll still take it."

"I'll let them know...?"

"If there's a way to take it to go, that would be even better."

"I don't think...."

"Also, I assume she didn't eat much of her breakfast-- do we get a credit on the account for that?"

"Her meals were covered in the overall cost of her stay."

"Oh, is she still being charged for the room until we leave?"

"I don't...."

"It's fine, we're going.  We left the teeth on the pillow.  Take care, doc."

"Sorry again for your--"

"Bye."

Getting Dumped

Sorry for almost a week since the last post.

Patient comes into clinic.  "So, how's the wound looking?  You've been seeing Dr. Dressing, right?"

"Sort of."

"What do you mean?"

"I've been trying to get another appointment, but he's refusing to see me."

"Refusing?"

"His secretary said that she wasn't allowed to make another appointment for me.  I saw him three times.  The wound was doing better.  So I want to see him again.  But they won't let me!"

"Do you have any idea why?"

"I don't know.  I had to cancel an appointment last-minute because the weather, but I can't imagine what else."

"And they didn't say?"

"The secretary said she couldn't talk about it."

"That's very strange."

"I know!  I was hoping you might able to call and get them to see me."

"I can call and see what's going on, but I can't promise that he'll see you.  I can try to get you a referral to someone else, though."

"I want to see Dr. Dressing.  He was making things better!"

"I'll see what's going on."

I give Dr. Dressing a call.  "Hi, this is a little awkward, but I heard from Patient Ulcer that your office won't schedule an appointment for him?"

"Yeah, he missed 11 different appointments.  I really can't deal with that in my practice."

"11 is a lot."

"No kidding."

"Do you know of someone else he might be able to see?"

"I actually referred him to my least-favorite colleague.  Patient Ulcer should see her instead."

"Okay, I'll pass along the name.  Thanks."

I call my patient.  "I spoke to Dr. Dressing.  He said you missed 11 appointments and he gave you another doctor's name.  Do you still have it?"

"I did not miss 11 appointments.  It was only 10."

'That's a lot of appointments to miss."

"I didn't feel like going to the doctor.  And what's the big deal?  I miss appointments with you all the time."

"I don't get paid based on how many patients I see."

"Then I'm just making your life easier by not showing up, aren't I?"

"Not really."

Hospital Visitation Policy

1. Visiting hours are 10AM-12PM and 2PM-8PM, unless you look like you know where you're going and don't stop at the security desk.  A visitor's badge is required, except it isn't.  Only two visitors per patient, except for people who don't ask about the two visitors per patient rule, in which case, one thousand visitors per patient are allowed at any given time.

2. No children are allowed to visit patients, especially adult children, because they are the most irritating visitors.

3. If you are sick, please only visit Mrs. Terrible in room 934.  It would be great if she caught something.

4. Do not bring outside food into the hospital, unless you value the health of your loved one, in which case you should bring enough outside food that he or she can skip our meals.  Also, you should probably bring outside food for yourself, because if you eat the cafeteria food, you will likely end up joining your loved one as a patient.

5. The bathrooms are only for patients and those who are lacking a sense of smell.

6. Hospitals are busy places and patients are often on the move.  If you arrive and your loved one is not in his room, it is probably because he died and we forgot to tell you.  If you see any of his belongings, there has been a mistake -- patient belongings are immediately removed from the room by thieves when the patient is taken for tests.

7. There is a lost-and-found in the backpacks of most of our hospital interns.  There, you can find chargers for every possible type of cell phone and mobile device, along with hundreds of pairs of dentures.  Feel free to browse.

8. Everyone you see in the hall is a doctor, and specifically the doctor who treats your loved one, so we will all be able to discuss every detail of his case, calmly and patiently, if you stop us while we're on the way to resuscitate his neighbor.

9. The people with mops and buckets are the most informed doctors of them all, and will be glad to tell you whether your loved one took his medication today, or give you an update about his currently-happening surgery, since they also have devices implanted in their brains that allow them to see into operating rooms six floors beneath them and telepathically communicate with the surgeons performing the procedure.

10. Yes, we do make extra lunches for family members.  You may eat as much as you like and we will be happy to bring you more.  We can even cater to your food allergies and entree preferences, since we are here to serve you, the visitor, even if it's at the expense of our patients' health.

11. Please only discuss interesting parts of your loved one's medical history while in the hallway or elevator.  We are tired of hearing about their diarrhea.

12. Discharge will always happen exactly when we planned it a week ago, even if there have been complications in the interim.  So, yes, please come to the hospital prepared to take your loved one home, especially if you haven't talked to his doctors in days and know he's on a ventilator.  We'll even send you home with a few extra lunches.

13. Your loved one's doctor works twenty-four hours a day, seven days a week, and spends most of his time lurking just around the corner, waiting for you to need something from him.  So, yes, please get very irritated if he can't be found in three minutes when it's midnight on a Sunday and you want to find out whether that cookie your loved one got on his meal tray three days ago was actually sugar-free, or the nurse was just saying that.

14. Wear your most expensive white outfit when you come visit, because there's no way you will ever accidentally touch anything dirty.  This is a hospital, after all.

Enjoy your visit, and please come back soon.

Dead. Or not.

TO: All
FROM: Anon Doc

Hey, I just noticed in the system that Patient XYZ is listed as deceased, but there's no note.  Does anyone know what happened?  I saw him two weeks ago and he looked good.  Thanks.

TO: Anon Doc
FROM: Attending

Oh, wow, I saw him that visit too.  He did look good.  I wonder what happened.  Do you mind calling his family?

TO: Attending
FROM: Anon Doc

Okay, I'll give them a call.  But it's weird there's no note, right?

TO: Anon Doc
FROM: Attending

Maybe the family called but didn't give any information.  Let me know.

TO: Attending
FROM: Anon Doc

I just called.  He answered the phone.  Not deceased.  I asked how he was doing.  He said he was fine.  Said I was just calling to confirm his next appointment.  Do you know how to change his status in the system from deceased to alive?  I'm not sure how to do it.

TO: Anon Doc
FROM: Attending

Not sure, sorry.  Glad he's alive.  Maybe ask the helpdesk.  Thanks.

Rehab: Acute vs. Subacute

"So, they tell me you're giving them a problem about going to rehab."

"No, no problem, they're telling me I don't qualify for acute rehab and they want to send me to some kind of nursing home."

"They want to send you to a subacute facility, yeah."

"I don't want to go to a nursing home."

"You won't be in the nursing home part."

"It's still a nursing home."

"It is."

"You told me I could do rehab in the hospital."

"I told you that if you qualified for acute rehab, you could do it here.  But you didn't qualify."

"Why not?  My insurance is good."

"Your insurance is fine.  It's because you're not able to do enough hours a day of rehab.  They wrote in the note that you've refused rehab for the past three days."

"I was tired."

"Right, but in order to get into acute rehab, you need to demonstrate an ability to do a certain amount of exercise.  And you haven't been.  It's an evaluation they have to do.  It's disappointing, I'm sure, but as long as you're trying your best, this is going to be a better fit."

"I can do exercise.  Just not when I'm tired."

"But if you're tired here, you're going to be tired there."

"No.  My wife said she would do the exercise if I couldn't, and then she would show me how to do it when I'm not tired."

"It is not beneficial for your wife to do the exercise."

"It sure is.  My wife is fat."

"Okay, but these exercises specifically are designed to strengthen you, not her.  You're the patient."

"She needs as much exercise as she can get."

"Everyone should exercise.  But we're talking about your rehab, not her exercise."

"If you make her do exercise, I'll do rehab."

"I don't know how these things are related.  You need to do rehab."

"If my wife gets to sit on her butt all day, I'm gonna do the same."

"You need to do rehab."

"And all she does is eat."

"We're talking about you, not your wife."

"Can she go to rehab with me?"

"Not unless she has a medical need."

"The system sucks."

"I'm sorry."

A Hamburger, Fries, and a Heart Attack

I stop in to check on one of my patients in the hospital.

"How are you feeling this morning?"

"Great!"

"Well, that's terrific.  You're in good spirits, for sure."

"The surgery team just came in and told me to eat whatever I want!  They said I should have someone bring me a burger and fries!  Can you bring me a burger and fries?"

"I can't at 8 in the morning... but also I'm not sure I should... or that anyone should.  You're sure they said burger and fries?"

"They said I needed more calories!"

"Right, but you don't need the salt and the fat... maybe they could get you some more Ensure?"

"That stuff is nasty."

"Maybe, but I don't know if they were looking at the whole picture.  Burger and fries may have just been their way of saying you need more nutrition.  I can take a look in the system at your labs and give the surgeon a call to check in...."

"Are you ruining my good news?"

"I think I might be.  I just don't want to see anything go wrong from a cardiac perspective.  I know the surgery team wants you strong for the procedure, but I'm just not sure those are the perfect dietary choices.  Besides, have you had a hamburger from the cafeteria?  They don't look good."

"I didn't want one from the cafeteria.  There's a McDonald's like three blocks away."

"I know.  And that's probably even worse."

"You are spoiling this great day, doc."

"I don't want to spoil it.  But I also want to make sure we don't inadvertently cause any problems.  I'll talk to your cardiologist and see if he can connect with the surgery team and make sure everyone's on the same page.  If they're cool with the burger-- I'll see what I can do."

"Bacon cheeseburger?"

"Unlikely."

"Worth a try though, right?"

"Absolutely."

"So the two of you are partners?"

I walk into the exam room with my attending, and introduce her to the patient.

"The two of us work together, and she's going to take a look at you, if that's okay."

"So the two of you are partners?"

"Sort of.  I'm in my fellowship, so I'm still being trained, and she's one of the attendings who supervises."

"So you both get paid for seeing me?"

"We both get paid regardless of whether we see you.  I get a salary.  It doesn't change based on whether I see you or not."

"So how do you split the profits on me?  50/50?  Or do you get more because you spent more time with me?"

"Like I said, I don't get anything for seeing you.  I get paid a salary.  It doesn't change based on how many patients I see or how much time I spend with them."

"So you want to spend as little time with me as you can and go see the patients who pay you?"

"No.  No patients pay me.  Medicare pays the hospital.  The hospital pays me a salary.  I spend as much time as I need to with you.  I have other patients waiting, but there's no monetary reason why I would spend less time with you."

"What if I paid you directly?"

"I get a salary.  Patients don't pay me."

"But would you spend more time with me if I paid you?"

"There's nothing I could do for you with more time.  I'm spending the right amount of time with you.  You paid into Medicare your entire working life.  Medicare pays the hospital.  If you have a co-payment, that is something you and Medicare deal with.  I don't deal with your money.  I don't know how much you pay, or who gets it.  Doesn't matter."

"Matters to me."

"Okay, but it doesn't matter to me."

"So if I pay you a little bit on the side, you can't give me a better medicine or something like that."

"I can't give you any medicine.  I can just write prescriptions.  The pharmacy gives you medicine."

"So if I pay the pharmacist, I can get better medicine?"

"No.  You get the medicine I prescribe, which is the medicine you need.  We're not holding back the good stuff for the people who pay more.  There's nothing better than what I'm giving you."

"That's not very reassuring."

"Medicine isn't perfect.  We're doing our best."

"You would do better if I gave you more money."

"I wish that was how it worked.  I would love to be able to charge patients for the good doctoring.  But it just doesn't work that way.  You're stuck with the best we can do, and we're stuck with our salaries."

"I thought doctors got rich."

"Some might, but fellows don't."

"So you're saying the women do?"

"No.  Fellow means someone still in training.  It has nothing to do with gender."

"That's confusing."

"Sometimes."

Hyperbolic Chambers

"...so I notice you still have your foot.  That's great."

"Yeah, the surgeon really wants to amputate, but a friend told me something about a hyperbolic chamber, so I think I'm going to try that first."

"You mean a hyperbaric chamber."

"Whatever, yeah, I guess.  They're good, right?"

"Honestly, I don't know a lot about hyperbaric chambers, and certainly I don't know the specifics about whether that's a reasonable plan for your foot.  I'd listen to what Dr. Surgeon says.  That's his expertise."

"He says he wants to amputate, or I could die of a septum infection."

"A septic infection."

"Yeah, yeah.  But I'm going to try this hyperbolic chamber thing.  Cause, you know, if I don't, I'd always wonder what if I could have saved my foot."

"Again, that's something to talk to Dr. Surgeon about."

"No, my friend got totally healed from the chamber thing.  He had this burn on his skin, and it was like a miracle."

"Okay.  Your issue is different from a burn.  You have a wound that isn't healing because of a lack of blood flow."

"Sure, but if it can do one thing, it can probably do lots of things."

"I don't know what it can or can't do, but, generally, that logic doesn't really work.  Some treatments are very good at very specific things, and not good at all at things that are not the same."

"No, if something works, it works."

"Well, like, you wouldn't take medicine that's great at treating infections if you had, say, high cholesterol."

"Why not?"

"Because different medicines do different things."

"No, no, if it's good, it's good.  And I'm telling you, you didn't see my friend, the hyperbolic chamber is an amazing thing."

"Hyperbaric chamber.  And I think you're being a little hyperbolic when you talk about it."

"What?"

"I was just trying to be funny.  Never mind."

"I don't get it.  You're not funny, doc."

"Yeah, don't worry about it.  Just, please, talk to your surgeon and make sure he's on the same page.  Septic infections are a real risk."

"I'm telling you, the chamber is going to heal this thing up.  Maybe fix my blood pressure too.  The oxygen, pressure, I think it's all related."

"It's good to be optimistic.  Make an appointment for six weeks and we'll see how you're doing."