If hospital patients were treated like office patients

Scene: Coronary Care Unit at Midwestern Hospital

First year resident picking up phone to call attending cardiologist after evaluating a new admission: “Dr. Heart, this is Dr. Doshi at MH CCU. I’m seeing Mr. Rubinstein who came in with chest pain.”

Dr. Heart: “Well, what did the EKG show? Are his enzymes elevated?”

R1: “I can’t tell you that.”

Dr. Heart, about to tear R1 a new one: “Why are you calling me before you have the relevant information, Doctor?”

R1: “Well, the ER wanted to get an EKG but Blue Globe Insurance doesn’t allow for ER doctors to order cardiac procedures. That’s why they transferred him to the unit.”

Dr. Heart: “For tonight, you’re the cardiologist. What does the EKG show?”

R1: “Well, that’s the thing. BGI only allows for a board-certified cardiologist to order an EKG. In person.”

Dr. Heart, about to lose his shit: “Well, let’s start with the basics then. Tell me his history and his physical exam findings.”

R1: “His chief complaint is ‘I feel like an elephant is sitting on my chest’. I can’t gather more information without a prior authorization.”

Dr. Heart, humoring the young doctor: “And I suppose you’ve gotten that authorization then?”

R1, starting to sweat, and speaking as if reading from a script: “A prior authorization can only be obtained from the member’s primary care physician.”

Dr. Heart: “And I suppose you’ve called this person?”

R1, sounding a bit embarrassed: “Yes. But…she said that she cannot apply for a prior auth tonight because it can only be done by computer from a verified HIPPA-compliant terminal between the hours of 6 am and 7 am…Guam Standard time. Which she said is impossible because that was yesterday, or it’s next week, or something. And besides, if she requests an authorization she’ll lose her incentive payment without which she will not be able to afford computers, and without computers she can’t request prior auths.”

Dr. Heart, sarcastically: “Can you at least tell me it Mr. Rubenstein yet lives?”

Uncomfortable silence lasting several seconds.

R1: “Um, no. He’s been discharged. Care management said that he didn’t meet inpatient criteria.”

Heart: “And why is that?”

R1: “There was no history and physical or EKG findings on the chart to justify admission.”

Heart: “Then why are you calling me?”

R1: “The Quality Committee is reviewing your actions in this case and they are meeting tomorrow to decide whether to revoke your privileges. Oh, and shiva will be at the Rubenstein home starting tomorrow night.”

1 Comment

  1. Cynthia Currie

     /  November 16, 2014

    Twice this year, once at the hospital for a D & C and once during a colonoscopy, I informed the anesthesiologist (two different people) that I was not anesthetized. Both times I was ignored. I grabbed the nurses hands, I said loudly, “STOP! I am feeling this!” And both times I was treated as if I just wasn’t there. I really have lost my trust in medical procedures when this is the kind of treatment we receive by medical professionals.

    On the other hand, in the doctor’s office, I spend about five minutes with the aide being weighed and having my blood pressure and pulse taken, two minutes with the nurse confirming my medications, and another two minutes with the doctor while she renews my prescriptions and listens to my chest. When I try to bring up problems, she has to rush out of the room because there’s an emergency going on in the next room.

    Is this the medical treatment we pay thousands of dollars for?

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