Saturday, September 11, 2010

Candyman, Candyman,Candyman

I had a patient say to me " wow, your the Chief of Surgery, you must be good". I wanted to puff up and say "of course", but told the truth. I explained that I missed too many meetings so the ones who were actually at the meetings mad that they were there voted me in when they went down the list to see who hadn't already done it.

Anyway, part of my duties as "Chief" is to be the physician who oversees the risk management committee. It is amazing at what it tracked, everything from patient complaints, to infections, to food quality. On my desk last week was a thumb drive full of data from the ED. Outcomes and encounters are all tracked. They are broken down by diagnosis, provider, and shift. In all these data streams, we look for trends.

One of the things that jumped out was that there was a big difference in the number of patients seen by different physicians, this was independent of shifts. It also showed that the physicians were seeing the same number of true emergencies but that the difference was in patients there for back pain or "acute fibro". To find out what was going on, I called over to our head patient registar for the EDs. As a side note she is amazing. When people ask her how long she has been there she tells them that she was always there, they just built the ED around here). Anyway, she explained it all. She went down the list of docs and said, Candyman, Candyman, Candyman, HardA***, HardA***, B*****, Candyman and so one.

Sure enough, she matched the list. The word gets out quickly which docs are in the ED. In fact, people call the EDs to see which doc is where. The Candyman docs will write for a little pain meds to get you through until you can follow up with your own doctor for your long standing pain. After all, your "pain is a vital sign". When there is a Candyman, everybody runs to the ED to claim that their pain is "horrible" to get their fix. When there is a HardA***, the ED is quiet. She even explained to me that they alter their staffing depending on which providers are where.

As I was leaving she took a piece of paper off the stack of Memos next to here. It was from the med center administration. It was about a decrease in the Press Gainey scores for the ED during certain shifts. It recommended that they try to find the problem and then report back. I looked at the memo and then went to the office. There on the flash drive was the Press Gainey data. You guessed it, the scores were higher for the Candymen!


SeaSpray said...

Throckmorton!Congratulations! I am sure they still must think highly of you.

Okay ..I greatly digressed here ..but truthfully ..your post evoked a lot within me and so I will come back later to comment.
I realize it's only TV ...but in Grey's Anatomy ..the chief IS a big deal and the docs aspire to BE the chief someday. Ha! Right now McDreamy is the chief. Can't wait til that show starts ..although ..admittedly ..this once upon a time ...Surgery avoiding SeaSpray probably shouldn't watch it so as not to take in erroneous info that would scare needlessly... since she will be the surgical patient ..unless a 12th hr and 59.9 second miracle rescue occurs. :)

SeaSpray said...

Hi Throckmorton - you said "I called over to our head patient registar for the EDs. As a side note she is amazing. When people ask her how long she has been there she tells them that she was always there, they just built the ED around here)."

First of all ..I think it's great that you recognize her abilities. And second ... that is a good line on her part. :)

I LOVED working in that job with the emergency department and miss it now. When I was hired we were called registrars. Then in 90s patient service rep and since that patient access. Not sure why the changes in title.

I also looked up pt med recs (dates of visit all right there)and printed out when they had a patient in question for drug abuse/frequent flier visit (tooth aches and back ache - don't recall any fibro).

But I was never aware of what the ED docs prescribed ..except for one time. And that was only because a friend of mine called up expressing anger toward him for not believing her about the back pain. Too bad I wasn't there because I could've vouched for her. She felt humiliated and angry. I wish I could say what name she gave him but a twist on his real one and so can't.

So ...I asked a nurse about it when I went in. She basically said he hardly gives out pain meds and said it is a cultural thing with how he trained in his country before coming here.

Too bad all the abusers ruin it for the people truly in need of help. And that physicians have to worry about it too.

I would think administration realizes that complaints are not always reliable. The docs that try to monitor the meds should be rewarded. Only one thing ..I think it would be awful if a deserving patient were denied because docs are *understandably* jaded.

I know of someone (couple of years ago) who was erroneously given 90 vicodin ..NINETY ...instead of thirty by Walmart Pharmacy. I immediately said "You HAVE to give that back!" They flat out told me "No ..I see it as a gift." I said but then then someone will be off in their counts and they are accountable for the missing meds and could get in trouble." "No's a gift. They then went on to say how 2 other people needed it for pain also." !!! Their actions worried and disappointed me greatly. Maybe I was wrong ..but I dropped it and never brought up again.

What the person apparently didn't realize (I tried to tell them), that the Doc's give what they need for a specific problem. They are running the risk of ADDICTION to use it when not necessary. Fell on deaf ears.

And not long after that ..the next time I went back to the Walmart Pharmacy ..there was a new sign up stating changed policy with prescription pick ups. I don't recall what it was but at the time I wondered if that vicodin prescription was the reason.

I know I can be hypervigilant in some things ..but that person was just plain wrong and playing with fire.

I would hate to be in a physician's position trying to determine if pain is real because I sure as heck wouldn't want to be taken advantage of, lied too, etc ..but I also wouldn't want to deny the responsible person in pain.

I think they should only give enough to carry over to see their physician ..but then they will say they don't have one.

I did feel sorry for *some* dental patients tho, because I knew they were poor and could not afford dental work. Heck it's a lot even when you have dental ins.