At the hospital, I’m Dr. Nobody

Today I had a very special experience, one which many of my patients have faced: I was treated like a nobody while at the hospital. Yay me.

I went to visit a patient who was admitted over the weekend to see what was going on.  She was a bit upset about the confusion of the hospitalist service and how orders apparently didn’t get written for her care by the admitting physician.  That’s been resolved, but there are still many questions about what is going on with her and I thought that maybe I could help.

I was actually hired by this hospital when I first came to Augusta 20 years ago.  They paid for my first two years’ salary and got my practice up and running.  After concluding we could run our practice better than the hospital, we left their employment to run our own business.

I continued seeing inpatients in that hospital over the years, although I did give up the practice of admitting my own adult patients, opting to use the hospitalist service — something that was still fairly new when we went over to it.  We felt that the negative of the loss of contact with our hospitalized patients would be greatly outweighed by the improved care we could give to the vast majority of patients who were not in the hospital.

This is a deal with the devil that many docs have made over the past few years, as the overwhelming burden of paperwork, codes, and insurance nonsense made us look for ways to simplify.  It’s a deal with the devil, though, because we lose contact with patients when they need us most.  This is made worse by the #1 rule most hospitalists seem to have: Never communicate with the PCP.  I’m not sure why they have that rule, but it has been consistent through my years of practice.  We PCP’s are either evil, stupid, or very dull conversationalists.  Hospitalists hate us.

Still, I am well-known to most of the other physicians in that hospital.  It carries a lot of memories and good feelings.  I was actually a bit excited to go there and perhaps bump elbows with the doctors and nurses who still know who I am.  But from the start, the experience was less than positive.  Since I am now a “nobody,” I no longer have access to the doctor’s parking lot and had to park with the “common folk.”  This is fine, but the patient lot bakes in the hot Georgia sun and was packed, resulting in a long, hot walk to the building.

The hospital’s changed a lot since I was seeing patients there.  With all of the economic pressures they face, I find it curious how many multi-million dollar “improvements” get done on a regular basis.  Walking in, it looked totally different and I knew nobody.  The elevator was dressed nicely in real wood paneling and multiple advertisements for their da Vinci robotic surgery.  They spent a lot of money on those robots, and need to get some of it back (despite a lack of evidence robotic surgery is better).

My patient’s ward was the usual mix of patient moans, nurse call chimes, IV alarms, and distracted nurses.  I found the room and went in, greeted with a big smile from my patient and her husband.  They told me the tale of woe, recounting the sickness itself, the ER experience, the orders neglected, the doctors not answering their pagers, and finally the nice hospitalist they finally saw.  They couldn’t answer many of my questions, as they hadn’t really talked to many people despite two days passed.

I went out to get a pen so I could give my cell number to the hospitalist (hoping he doesn’t remember rule #1), plus I wanted to see if I could check the chart and get some answers for my patient.  After being ignored by the nurses for a minute or so, I cleared my throat, winning an icy greeting from one of the nurses.  I explained that I am a PCP and needed a pen, also expressing my hope that I could see the chart.  “No,” she said simply.  “You can’t look in the chart unless you have privileges and have been consulted.”  She wordlessly added through her facial expression, “And stop wasting my time, you useless pile of crap.”

So now I wait, hope against hope that the hospitalist will break the hospitalist code and actually call me.  Today’s experience made me once again see how badly our system treats people.  I was Dr. Nobody while I was there.  Each patient in that hospital seems like a nobody attached to a set of problem codes and procedure codes (which may, by the way, be fixable using da Vinci robotic surgery!).  The nurses are overwhelmed and the doctors are hard to reach.  They don’t know my patient, and will soon forget about her when she leaves.  This is not health care, it’s a chaotic money-devouring machine.

I left there ever more committed to keeping my patients away from that mess.  My patients are not nobodies; they are people I’ve taken the time to get to know.  To them I am not Dr. Nobody; I am their doctor.

Take that, hospital.

Rob Lamberts is an internal medicine-pediatrics physician who blogs at Musings of a Distractible Mind.

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