As I feared the ability to think and solve problems is rapidly disappearing from the hospital landscape. Over the years I have witnessed my modest but well-established community hospital turn into a vast impersonal center of techno-medicine. I suspect that soon there will be a mono-rail connecting it to the Mother Ship at the University. I am a grown girl and I am not a Luddite. That said I am a staunch believer in the Art of Medicine as a humanist endeavor. My recent stunned blog silence was in part triggered by some mind numbing experiences at My Hospital. Here is one of them.
I had learned a few nights earlier that a dear, bright and independent elderly lady had fallen at home and broken her knee. Not that long ago she had had her hip replaced and would need the services of this same orthopedic surgeon. The emergency room doctor had spoken with the surgeon and was calling me to see if I would accept My Dear Little Lady onto my service and place a consult to the surgeon. The surgeons prefer this type of set up since a lot of older folks have other medical problems that need special management in the peri-operative period and this type thing is outside the surgical comfort zone. Of course the surgeon could accept the patient on his service and place a consult to me but then he gets the bothersome discharge planning and dictating and so on to do rather than me.
Now would be a could time to explain the concept of a "service." My service consists of all those souls currently lodged in the hospital and assigned to me as my primary responsibility for medical and bureaucratic management. We don't say "my patients" or "your patients" because most doctors are part of a group and any member of the group may be responsible for the hospital patients of all the other members of the group at any given time. Claiming the patient as "mine" for some physicians is quite uncomfortable since it implies a relationship with the patient that either doesn't exist or is not desired. In big academic settings where most doctors work for the University a "service" may be an entire medical specialty such as renal or infectious disease. This is the height of status and of anonymity.
Back to the story. My Dear Little Lady had had her knee fixed on the day prior and I was rooting around the nurses' station looking for her chart. I found it at the bottom of a pile at the elbow of a woman I didn't know. "Could I use My Dear Little Lady's chart?" I asked. "Who are you with?" was her reply. I felt exactly like I had felt one time when registering at a hotel near London and was asked for my name by the desk clerk. "Miss or Mrs?" she asked me. After an awkward silence I replied "Are those my only options?" So anyway I gave Unknown Woman a withering look and identified myself by name hoping she might put it together with my name on the chart. Alas no such dawning realization took place and I was forced to ask her just what her business was with My Dear Little Lady. She identified herself as the representative of Dr. So-and-so. She herself apparently had no actual name rank or serial number. I don't have the pleasure of knowing Dr. So-and-so and had to ask in follow up who the hell he was and what his schtick was all about. Meanwhile I forcibly removed My Dear Little Lady's chart from the pile and opened it. It rapidly became clear that Dr. So-and-so was some internal medicine doctor who was equally unknown to My Dear Little Lady and who had been invited by the surgeon to come and manage My Dear Little and remarkably healthy Lady's non-existent medical problems. I proceeded to explain that the services of the esteemed Dr. So-and-so would not be needed and with a pleasant smile and a flourish of my pen I disinvited Dr. So-and-so and his lackey. I find that these things are best handled with a smile and a flourish but it would have been most satisfying is Unknown Woman had disappeared with a pop at that point.
After evaluating My Dear Little Lady, saying nothing about the little tussle at the desk, I returned to the chart and found that the surgeon had written a consult to Dr. So-and-so as part of his pre-printed post-operative orders. The pre-printed orders are supposed to reduce medical errors but they have an untoward side-effect of causing physicians' brains to shut off as apparently had happened to the orthopedic surgeon. I'm quite sure he knows nothing of this oversight and couldn't care less if he did. I felt no need to chide him over it as it would have been a waste of breath on my part. He and I are largely along on the same wild ride of standardization and efficiency currently dis-serving My Hospital.
Later that morning I paused as I crossed the main lobby on my way out because I thought perhaps a concert was being performed nearby. To my mounting horror I realized that what I was hearing was a xylophone and harp version of "Desperado" being piped in apparently over a new Muzak system. I suspect this is meant to conceal the subliminal messages that are coming next.
