Doctor, Are We Focused on the Right Things?

Doctor, are we focused on the right things? Honest to God, its 3:10 AM. I can’t sleep, but I feel so lucky. One of my patients died last week. My wife of 30 plus years is asleep next to me. How lucky am I?

Judy presented to me about 10 weeks ago with acute sciatica, and low back pain.

At first, it seemed simple enough. By the end of week one, I sensed something completely different. Nothing gave her anything but very passive relief, nighttime was unbearable. Then she developed significant weakness of the legs and gait changes. Interestingly, her neuro signs were still benign, but that changed oh so quickly within 48 hrs. Something was “bad wrong”, here as one of my earliest professors would say.

He husband who I have cared for for 25 years was with her every moment. Very concerned. Scared for Judy.

I called her PCP who immediately began a hospital intake after we both voiced concerns about unrelenting night pain and progressive leg weakness now justifying admission and a complete workup.

Judy went down-hill fast. Initially, what started as a simple sciatica was next thought by her neurologist to be Gullien-Barre’ Syndrome.

When medication (steroids, etc) did not help significantly she then quickly had plasmapheresis, and was sent to transitional care. She never improved significantly.

Very quickly, it was established she had some very aggressive non-specific demyelinating disease.

In essence, all this happened inside of 3 months.

Judy and Bob were married for 50 or so years. Over in a flash. There is nothing any of us as her team would have done any different, or better. But, it still sucks.

Of course we see this as part of practice, and way more if you spend a lot of time in hospitals. I did four years of this type of transitional care, and I still see the face of the pretty 23-year-old girl dying of a brain tumor, and many others 30+ years later.

So, yesterday morning, after my staff broke the news (we had called Bob the night before to check on Judy), instead of bitching about how so many obstacles are being hurled onto the path of us in practice, I felt really lucky. I immediately thought about my wife and daughter.

For some reason next I start thinking this morning about the doctor from an insurance carrier trying to lecture me on another patient last Monday morning on absolutely ridiculous daily record keeping, way beyond any standard of care. I told him so. I also told him I would gladly perform a high level encounter at each visit as long as it was paid for. I also explained that the company he reviews for denies such services as “not medically necessary”, so this will cost the patient an additional 150 or so out of pocket, for each flare up of the SAME condition.

Huh?

And I am thinking this is just nuts. There’s no common or rational clinical sense in this at all. This is not good chiropractic or good medicine.

And I told him, “Screw all of this. Patient care always has to be the most important thing here”.

He’ll never get it.

A year ago, it still made sense to work for these people. I’m still #lovinghealthcare

But, if this keeps up they are history in my book.

Because when its done, that’s all there is.

 

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