I’m on call for our internal medicine practice this weekend. (Not the holiday, just the weekend.) Call is not what it used to be, which is a good thing. We no longer cover our own inpatients. I know it’s been an alarming change for some of our longtime patients, many of whom have had a stay or two at our great institution. Their care during their admissions would have been directed by their own primary care physician, or one of the other providers in our relatively small practice. They probably would have met all of the other providers at one time or another. In any case, at a time of crisis, they would have seen a familiar face and known that they were known.
What they didn’t know was that in recent years, the complexity of this arrangement probably compromised their care. On the outpatient side, tighter budgets and a steep rise in accountability have created unbelievably increased workloads. More volume, more paperwork. Our productivity is being monitored to an extent that it never was before.
On the inpatient side, the sheer the number of tests and treatments, relentless changes in practice guidelines, and endlessly updated recommendations have made it very difficult to keep up. It’s a tidal wave of information and logistics to manage, and at a fast pace.
How we straddled both of these increasingly divergent worlds, I have no idea. I was one of the holdouts, too. I didn’t think I would be a “real” doctor if I wasn’t managing inpatients. And so weekend call meant driving in to work and rounding, seeing admissions, talking to nurses and residents and specialists, writing notes, as well as answering any pages from outpatients. Weekdays were running to see inpatients and do all of that, then running back to the clinic to see outpatients, with responsibilities often overlapping. Or, if we blocked clinic time in order to devote ourselves completely to the inpatients, we took a hit on productivity that was difficult to make up.
And then, there were complications. A few of us made mistakes. I know I did. I discharged a fragile elderly woman on the wrong dose of a medication. She crashed at the nursing home and ended up back in the emergency room. It was a medication error and a readmission: a double no-no. (She was fine, but.)
I got scared, and immediately joined the ranks of those who were done with it.
Now, when I have a patient in house, I check the chart, read the notes, try to go and see them, or at least call. Sometimes, many times, I’ll chat with the nurses or the team and just make it known that this patient is known. I think it helps get them a different level of care, and it helps me when I have to pick put the case on the other side of the admission. I can’t do this all the time, and usually reserve this effort for medically or socially complex folks. It takes time, and time is really limited.
Still, when I’m walking the hospital hallways with a purpose, I do feel more like a real doctor.
Do I miss it? Hell, no. I’ll never forget that gut-slamming sickening sensation, knowing that because I was rushed/ distracted/ trying to be in too many places at the same time, I made a dosing error that caused a seriously bad outcome for a very sick patient. I’m very happy to leave the direct management to the hospitalists who do this all the time, or the seriously impressive resident teams.
What a prelude to the real story that was! And so. This weekend. Hubby left with the team yesterday morning, and I’ve had the kids. Yesterday there were multiple flurries of phone calls, mostly UTIs, sinus infections, and “I’m at my in-law’s and I forgot to pack my blood pressure meds”, and a couple of very sick folks who needed to go to the emergency room. Yes, my kids were trashing the house and absolutely killing each other while I was on the phone… There were a few calls where the patient and I couldn’t hear each other, and I had nowhere else to go. “Sorry ma’am, it’s a small house. Did you say you were having fevers?” People understood. There were some hairy moments, but nothing like it used to be, when I’d be straining to hear an ER doc giving me the story, trying to jot down notes, my mind struggling to shift into inpatient mode, knowing I’d be examining this person the next morning.
This weekend, the kids and I stayed close to home. We made play-dough; put up our outdoor Christmas lights; did a bit of raking; filled our bird feeders; baked banana bread. They watched the Charlie Brown Christmas movie, the Winnie the Pooh Christmas movie, the Caillou Christmas movie. I made Turkey Shepherd’s Pie and Mexican Turkey Soup. I also did just about all of my Christmas shopping, online. And now, with both kids snoring under their down comforters, the dishes clean and the laundry going, I’m sitting on the couch watching some football.
My, how times have changed, and I am very thankful.