Common Sense is Rare Indeed!


My wife, smart lady that she is, just noted that today it seems that it is so much easier to purchase almost anything in our retail market than to find adequate health care. This is not excellent, just adequate health care that we are speaking about.

Day to day interaction with my patients and their insurance carriers reinforces that comment.

So, this is my post where I get to rant.

For example, one of our friends called me because her significant other was having difficulty breathing. When I spoke to him on the phone I could heal him wheeze and try to catch his breath while talking and was relating to me his difficulty sleeping, laying down and that his feet ankles and calves were severely swollen. These “symptoms on top of fluid in his chest on a recent chest x-ray????

So, his primary care doctor tries to get him to see a cardiologist coming to the same conclusion that I did with the diagnosis of congestive heart failure, especially in light of his previous visit to his cardiologist who found no changes. Congestive heart failure is a diagnosis where by the heart is basically overwhelmed either by a leaky valve or decompensation of the heart muscle, such as a myocardial infarction (heart attack) where there is a back up of fluid into the lungs, which fill up and basically drown the patient.

The soonest that the cardiologist can see the patient is 2 weeks from next Tuesday. Unbelievable and unacceptable! So the friend calls me and in combination with the primary care doctor we manage the patient and get him an appointment in a “few days.”

He is seen, has a number of tests and finds out that he doesn’t have changes to suggest a heart attack and then schedule him for an MRI/CAT scan. This is a somewhat more sophisticated type of x-ray to see the soft tissues, in this care the heart and lungs. He is then diagnosed with a condition called restrictive pericarditis. He is then shipped out to a hospital where they can do a surgical procedure where they make a “pericardial window” to ease the restriction on the heart and allow it to function better.

I know. You are all saying so where are you going with this rant! It gets better.

So, the patient is now breathing better the day or two after surgery, except from diarrhea, elevated potassium, a necessary mineral for the heart muscle to function correctly and some recurring swelling in his ankles. The potassium comes down with corrective medicines and the diarrhea stops Saturday evening, where by they discharge the patient.

Now early Sunday morning I get another panicked phone call telling me that the swelling is now severe, the patient hasn’t urinated since yesterday, the patient’s breathing is “labored” and he can’t stay awake.

I’m just a simple surgeon, actually a plastic surgeon, and what do I know about medicine since all I do is “cut people open and sew them back together.” But the intelligent part of my brain, very small for surgeons, or so I have been told, screams at me that this patient is in renal failure (kidneys not working) or he has more fluid accumulation. I suggest, in very strong terms that the patient needs to be dialyzed, take the excess fluid off so that his heart doesn’t fail and so that he can breathe.

Yes, he gets admitted to another hospital, due to the fact that the hospital where he had his procedure is fairly far away and his significant other and I were worried that he might arrest, die, if she tried to travel back to that hospital. He is now in the hospital that I suggested where he is having all sorts of tests to try to find out the reason for his kidney failure or reason for the “window” procedure “not working.”

Why am I upset, you might say angry? The patient probably should have been kept overnight instead of being discharged from the hospital where he had his procedure, especially in light of all the problems that he had before the operation as well as the problems after the procedure.

Common sense would lead you to that conclusion. Right? Where was the common sense in the decision making or in fact what was the clinical decision to discharge the patient based upon?

I really believe that common sense and good decision making in medicine is gone.

The patient needs to be discharged based on the coding numbers, diagnostic code, which allows so many days in the hospital. Other wise the hospital will not get paid. Yes, a doctor makes the decisions based on the administrational orders from above, based on the almighty dollar and not the clinical assessment of the patient.

There is something just so wrong with decisions made by the bottom-lined, the financial numbers and not for the safety of the patient.

Here is an example of a poor process, which needs improvement. If not, in the future, the readmission will not be paid to the hospital as well s the physician.

We need to benchmark and decide on the most effective and efficient way of caring for our patients so that we have built in safety factors fro the ever-changing patients and to assist the doctors and the nurses in decision choices.

If this continues the lawyers will have a field day and there will never be a case for trot reform to quell the malpractice problem that we have in our sweet country, which adds to the huge cost of health care and if not corrected a non sustainable situation where the only way that “Affordable Care” to persist is where the Government adds to our already high taxes and sets limits on care-the death panels.

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