Monday, November 28, 2011

Post Call Funk

     I am post-call and feeling funky, in the most unpleasant way. Taking 24 hour in-house call is like being an anesthesiology resident all over again: unpredictable emergencies of all kinds at any given hour are de rigueur, which combined with little or no sleep, create a Circadian biorhythmic hell. You get strange consults from the ICU at 3 a.m. that usually involve a request to place a central or arterial line in someone who is barely being kept alive on a ventilator with maximal hemodynamic support through a tiny peripheral IV, along with continuous dialysis. You are essentially being asked to go fishing for IV or arterial access on a dead person. Sometimes, the person actually has "do not resuscitate" orders on his or her chart, but these appear to be largely ignored in the quest for last ditch interventions.
     I am perpetually amazed by the lengths physicians will go to sustain life, with a seemingly complete disregard for the quality of life (or lack thereof) that is to follow. As a physician, I have sworn to "do good" and "do no harm" to my patients: to me, this includes knowing when to stop! I am somewhat of an anomaly in the world of private practice anesthesiology because I value patient safety and advocacy at the expense of "cutting corners" to keep surgeons and interventionists cranking out elective cases so that hospital and insurance administrators can stay very, very rich. Why does there even have to be such a trade off? Until American healthcare becomes less focused on expensive damage control, and gets out of bed with the insurance industry, big pharma, and greedy corporations, physicians will continue to be pressured to "produce", instead of "prevent".

6 comments:

  1. I should elaborate/qualify the comment about "the world of private practice anesthesiology"...in my current practice, there is a LOT of pressure for us to produce; that is how we get paid. It's the "eat what you kill" model of reimbursement. Cancelling a case because a patient hasn't been NPO is considered a mortal sin by our administration, yet proceeding with such a case under suboptimal conditions violates my committment to "do good/do no harm." Coming from academics, where I taught residents the "right" way of doing things and felt my professional opinion was usually valued by my surgical colleaques, private practice was somewhat of a culture shock. If there is a private practice group out there where the docs don't feel pressured to move cases along where patient safety is in question, I'd love to hear about it!

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  2. Thank you for creating this blog and getting the conversation started on health care in this country. Personally I want to learn as much as I can about herbs and alternative ways to heal so that I have options when I'm able to. Your insights into what happens in surgery and in the medical culture in general is really enlightening.

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  3. You are articulating my sentiments exactly. In my naiveté I used to wonder why a central line was being inserted in to a circling 85 year old, already tugging. When I finally realized that providing interventions paid the bills (and some), whether they made sense or not, it was like a light switch was turned on. Doesn't leave me with a lot of respect for our healthcare model. I support your musings on this subject and am very glad we have an advocate who can articulate the inconsistencies of this broken system so well.

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  4. Thanks for the supportive comment, you guys! I am hoping to generate some fruitful discussion here. There is no right or wrong opinion. This topic weighs very heavily on my mind, and it feels great to have found a platform for expressing my thoughts!

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  5. Kris, if I could pick an anesthesiologist, I’d definitely want you! I agree wholeheartedly with your last line about American healthcare being in bed with big pharma, insurance companies and greedy corporations. I have seen direct evidence of this over and over again with family and friends, and especially with the quality of healthcare (or lack thereof) that my late mother received in her later years. You make some really good points in your post.

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