Sunday, October 27, 2013

This is a Hospital, NOT a Hotel

      I had no idea until I started my intern year, that people are very resistant to leaving the hospital. At least the people that reside in this borough of NYC. It makes little sense to me really, I mean, who wants to be in a hospital?  80% of my patients apparently. If I were a patient and the doctor told me that I could leave, I would jump for joy. However, it is usually a fight to get my patients to leave when we are done caring for them medically. Technically, we need to give them 24 hours notice that they are being discharged, and then they HAVE to leave, but we never do that here. The thing that disturbs me the most, is that the social workers, doctors, nurses, and everyone else taking care of the patients here just allow them to stay. As if this were a hotel. Which it kind of is to them. They are waited on hand and foot, get their meals brought to them in bed, get great pain medications, sleep aids if they need them, and individualized attention that this population of people likely do not get at home. Here is MY problem though: This is a city hospital, and the bill is paid for by you and I and all of the other taxpayers contributing to both Medicare and Medicaid. PLUS staying in the hospital makes patients sicker (they pick up infections, pneumonia, etc. from just sitting here) which leads to further problems in general. I have had patients refuse to leave because they claim they have no ride home. There are always buses and cabs (at least in my world). "How much does a cab cost?" they have asked before stating "What is the big deal if I stay another night here?" Well, I want to tell them (but I don't), a cab is about $25 dollars, and another night here is at least $1,000 of the tax payers money. So really, they mean what is another night to them. Nothing. It is all of the people collectively that use the hospital as if it were a hotel that is taking a big toll on our healthcare system. If we took all of the money that is thrown in the garbage by allowing people to stay in the hospital when they need no further medical treatment, it would allow us to channel it towards a lot of other people who need healthcare but do not get it.

P.S: I have had the son of a patient ask if we could keep his mother here for the week while his family went on vacation. Note to all: if the hospital is not a hotel, it is certainly not a kennel.

P.P.S: I have also had "social admits," for example, a man who was admitted because his wife broke her hip (and was a patient on the ortho service), even though there was nothing wrong with him. I was told that because he was dependent on his wife for his activities of daily living, there was apparently no other option.

P.P.P.S: Last week, I had a patient who was sneaking candy so her finger stick glucose values would shoot up and we would not be able to discharge her.

P.P.P.P.S:  I have been told that by the end of the year I will be so jaded by all of these social issues that I will not feel the need to comment or worry about them anymore. I guess we will see.

Monday, October 21, 2013

Patient Encounter

Vascular Surgery Clinic: I have already seen and examined the patient, presented to the attending, and we are going back into the exam room to speak to the patient together. The patient is 16 years old, so her mother is with her. The patient is status post embolectomy (an embolus was removed from her thigh area) in the catheterization lab.

Attending: " I think some compression stockings would be good for your daughter as her thigh is still very swollen."
Patient's Mother: "Medicaid won't pay for them."
Attending: "Well, you could pay for them."
Patient's mother: "They are very expensive!"
Attending (looking at the take-out bag of donuts and Starbucks coffee the mother is drinking): "They are not that expensive, and if you saved a little every day, you could buy them. Do you think your daughter's leg is worth it? I think your daughter's leg is worth it, and if you stopped spending your money on things like donuts, you could save up the money in a few days. You may also lose a little weight, so it would be healthier for you too."
Patient's mother: "What are you saying?"
Attending: "I am saying that you are carrying a lot of extra weight and if you stop eating donuts, you could lose some and save the money you need."
Patient's mother: "I don't need you to stand here and tell me that- who do you think you are? Get out of this room."

We step outside...........
Attending: "People have this great sense of entitlement and do not want to pay for anything. I have had patients ask me for gauze to change their dressings because they do not want to pay for them, but they have enough money to buy themselves cigarettes to CAUSE these wounds. And they think it's other people's responsibility to pay for their actions. Now I understand that this lady was upset, but she has to face the facts. Donuts are not as important as saving her child's leg, and Medicaid does not OWE them compression stockings. They already paid for her embolectomy and doctor's visits."

Now.............I completely agree with the attending, I am just surprised he verbalized his thoughts to the patient. I also find it surprising that a physician who feels this way has worked so many years at this particular city hospital because the majority of the patients there have the same beliefs as this particular patient's mother. I will not even get into a Medicare/Medicaid/Obamacare discussion right now. Not enough energy....I am on night float.............this is what I need:

Tuesday, October 1, 2013

Pumpkin Crazy

      Happy October! My month in the SICU is finally over (but I have one more rotation there in June because anesthesia interns are required to do not one, but TWO months in the ICU during their first year of residency), and I am starting nights for the general surgery service at my program's city hospital tonight. I should be sleeping right now, but it is REALLY hard to transition from working from days to working at night (I am always so tired after that first night because I never get enough sleep the day before). From what i've heard from the other interns, this is going to be another really tough month. BUT if I can make it through, my next few rotations are rumored to be more laid back than the ones I have been on so far. RUMOR being the key word. It was also strongly emphasized to me that "laid back," means more relaxed within the context of a surgery intern year. Very different than the real world's definition of relaxed. Maybe it means I will be able to make it home before 8pm one day. Let's hope I can make it.
      Anyway, because it is October, one of my favorite fall months, I thought I would share some of my new festive fall food finds! Trader Joe's (aka the best grocery store ever) has really gone pumpkin crazy, and I have bought practically every pumpkin item they sell. Pumpkin is not only festive and delicious, but it is also a "superfood," extremely low calorie, and packed with vitamin A, vitamin K, beta carotene, and fiber. One cup of pumpkin has only 80 calories, 1 gram of fat, and 7 grams of fiber!

Some healthy, delicious finds.........

1.) Canned Pumpkin: One of my favorite low calorie side dishes is: Half a cup of canned pumpkin warmed on the stove with cinnamon and 1/4 cup sugar free maple syrup (only 60 calories and 3.5 grams of fiber).

2.) Pumpkin cereal and granola bars: The cereal bars have 130 calories, 2.5 grams of fat, 2 grams of protein, and 1 gram of fiber, and the granola bars have 170 calories, 6 grams of fat, 5 grams of fiber, and 4 grams of protein.

3.) Pumpkin Non-fat Greek Yogurt: 8 oz has 190 calories, 0 grams of fat, and 18 grams of protein to keep you full!

4.) Pumpkin Cream Cheese and Pumpkin Butter: The cream cheese has 70 calories and 5 grams of ft for 2 TBS, and the pumpkin butter has 40 calories and 0 grams of fat for one TBS.

5.) Not pumpkin but still FALL festive and delicious (so I had to share): Apple slices with low-fat caramel dip: The low-fat caramel dip has 120 calories for 2 TBS, and the apples have 80 calories, 0 grams of fat, and 2 grams of fiber for 1.5 cups.