A word of thanks to my hospitalist colleagues
The other day I got a call from one of the hospitalists who admit and take care of my patients for me. He had noticed no recent admissions for my office and wanted to make sure everything was okay. “I guess we’re just doing too good of a job up here,” I joked with him. Being “up here,” by which I mean too far of a drive from the area hospitals to make it practical for me to admit my own patients, has some distinct advantages.
After my first year in practice when the patient load at my office prompted me to stop admitting my own patients and asking a local hospitalist group to manage my inpatients, I felt a little guilty. Wasn’t this poor continuity of care? Would my patients ask the hospitalist, “But where’s my doctor?” These thoughts still run through my mind sometimes. But then I run across an article or two like the ones referenced below and I can’t help but be thankful that I stopped practicing inpatient medicine.
WhiteCoat reports on the arrival of JCAHO at his hospital:
Secret phone calls go out to everyone. High alert. High alert.
Half-filled coffee mugs sitting on the counter mysteriously disappear.
Charge nurses run ahead of the group with a bunch of keys making sure every bit of medicine in the hospital is on lockdown.
Things that don’t have a place to go get thrown into a closet, the closet gets locked, and a sign gets put up saying “Bathroom – Out of Order.”
All the “procedure” books are prominently displayed.
Everyone acts busy.
Then a little group of people with suits, bright white lab coats and clipboards comes trotting through the ED. One of the hospital administrators is walking behind them frantically motioning to the ED tech to take the patient chart off the counter and put it behind the desk.
Included within the group are several clipboard nurses and a few other unidentified surveyors.
The clipboard doc is the best. He’s about 70 years old and is a retired dermatologist. He looks kinda lost. He just walks around listening to people tell him what to do.
Out of all the safety measures in the hospital that they had to survey, we got dinged because one of the charts had an “unapproved abbreviation” and because there was a lidocaine bottle that wasn’t locked up after we got done sewing up a laceration. But Clipboard Doc, not to be outdone, dinged us because … we had holiday stickers up on the windows of the trauma rooms.
After all, those holiday stickers “have static electricity and could cause a fire.” In addition, they’re probably “teeming with bacteria and could be a source of infection.”
Then there’s this article from the New York Times about “disruptive” physicians:
More nurses are challenging doctors on their inappropriate behavior, and fewer hospitals are tolerating disruptive doctors. “Today they’re getting rid of that doctor or sending them to anger management,” said Dr. Thomas R. Russell, executive director of the American College of Surgeons.
Some physicians worry that hospital administrators will abuse the stricter codes of conduct by using them to get rid of doctors who speak out against hospital policies. And the Joint Commission rulings have spawned a cottage industry of anger management centers and law firms defending hospitals or physicians.
So let me go on record and say thank you to my dear hospitalist colleagues. While private outpatient practice has its downside, I don’t have to worry about being bothered by that odd little specie of humanity known as the JCAHO bureaucrat. No clipboard-wielding non-entity haunts the halls of my office pretending that his quest for fabricated problems and make-believe dangers somehow contributes to patient care.
Nor do I worry about be infantalized by my own staff. As the owner of my own practice, there is no overpaid, suit and tie-clad drone who has never had a real job plotting to launch a witch hunt against me for being “disruptive”. If I raise my voice in anger it is almost certainly in response to stupidity, and the solution is not for me to restrain my emotions but for the stupid behavior to stop at once and never be repeated.
You, my hospitalist friends, have my deepest appreciation. I merely practice on the front lines of medicine. You are deep in enemy territory!