Tuesday, March 08, 2005

Hospitalist hours today

I had fun this morning. I am augmenting our usual hospitalist staff while the census is high. It's nice that I don't do it full time. Actually, I have so many jobs that I don't get tired of any of them, although I do get tired of the whole thing some times.

But this morning I think I actually did some good things. One of my patients was hospitalized for pneumonia and will be discharged to a skilled nursing facility. The signout I got was just to write nursing home orders and make sure she got out the door. When I went to see her, I noticed she had a sling on her left arm and asked why. She (and her sister) answered that she had fallen and broken her arm on 12/26. I then remembered why she looked so familiar. I had taken care of her in the ER that day! Anyway, I asked her how much longer she was going to have to wear the sling. She remarked that she had an appointment with the orthopedist on 3/11. I didn't see any reason to have to haul her out of the nursing home to the ortho office in 3 days (and pay for the ambulance) so I ordered the appropriate x-rays and called the orthopedist who saw her today before she left. How cool to make something like this easier for her.

Another patient was a curmudgeon (I hope I spelled this right, I usually use ***hole) who was in line to go to a very good rehab center but wanted to go home and do outpatient physical therapy. Nothing against the PT program locally, but I would certainly want my family member in the rehab center. He expected the same response from me that he received from several others--argument and active resistance to his decision. I sat down and said, "OK, let's talk about it." I reassured him that he was in charge of his health-care decisions and that I was not going to handcuff him to a gurney (besides, my cuffs were outside in my SWAT bag and it was raining out there) and force him to go the rehab center. I asked him about his concerns about the center and his hopes for recovery. I told him I would write the order for the outpatient PT if that was his insistence, but that I didn't think it was a good decision. I pointed out that his chances of being admitted to the rehab center if he missed this opportunity were very slim. Finally, he teared up slightly and asked, "Doc, am I going to get use of my legs back?" I answered, "I don't know, but your chances are much better if you take advantage of this opportunity." He decided to go with the rehab center, convinced that I cared more about him than my "plan."

What a great day!