Sunday, December 23, 2012
Somethings are a pain, sometimes for the patient, sometimes for the doctor, sometimes for both. I go up to round and as usual the nurse and assistant are no where to be found. I check the chart and the computer and of course there are no drain outputs. I ask the patient and she says well they emptied it in the morning and it had "fingers pinched" about this much. Since that seems to be only a little bit and it has been in too long I decide to remove it. There are no suture removal sets anywhere because they are all locked up in the "clean supply room". I find a nurses aid who gives me the combination to get in to the room after she tells me, that "it is not her patient'. Once in the room, I find all the suture removal sets are locked in the "Suremed". I step out of the room and ask the unit secretary to page overhead the nurse who is taking care of my patient. Turns out she was in the back in a mandatory computer order entry class. Mad, she went to the supply room and came back with the removal set and went back to her class. The patient just looked at me and then asked, can I go home now?
Saturday, December 22, 2012
Lately it seems that every patient hints that they need some pain medication even when they are been seen for something that does not cause pain. Sometimes they get quite belligerent when their hint is ignored. We have tried several different ways to address this. The one that has worked the best is to have the nursing assistant who is checking them in to hint to them first not to ask for pain medication. This way it is caught early. Quite often, the patient just gets up and leaves.
The year is almost over and Boy has it been a year for big changes in our practice of medicine. We saw a huge decline in elective surgical and diagnostic procedures only to see a huge increase in the nonelective emergency procedures. We have shortages of life saving and generic drugs. The government is pushing to get patients out of the hospital faster and penalizing when they have to come back. We are rated not by outcomes and lives saved but whether or not we give enough pain meds so that we get good Press Gainey scores. The small community hospitals are closing or sending everything out. Catholic hospitals are getting out of the healthcare business. More children are losing their insurance. Mental health care is nonexistent. Doctors are jumping at the chance to opt out of Medicare and if you have Medicaid you are SOL. Doctors offices have to use electronic records that report your personal information to the government but do nothing to improve your care except decrease your access. When you go to the doctor, you may not even be seeing a doctor.