I'm always a little anxious during the drive to a funeral home to pay my final respects to a patient.
Last week, I took my first such trip since moving here, and the nerves returned. A paranoid voice inside me wondered, again, if someone at the viewing would blame me for their loved one's death.
Admittedly, this has never happened. Family members are invariably appreciative of these visits, and I am often introduced proudly to multiple family members as "So-and-so's doctor." These new acquaintances then usually shake my hand or even hug me. They sometimes express surprise that I am there (which makes me a little sad, since I was taught that attending patient viewings and/or funerals is a natural duty of the family physician and an important opportunity to say goodbye).
When a patient of mine dies unexpectedly, I usually comb through the chart, looking for any mistake I might have made. It's a ridiculous compulsion based on the impossible idea that I am omnipotent enough to foresee every possible problem that might happen to my patients. I'm not omnipotent, of course. And, no matter how good of a doctor I am, all of my patients will eventually die of something.
But I always wonder - did I miss something? And, I figure, if I'm wondering that, maybe my colleagues are. Or my patient's surviving family.
Overall, I consider myself reasonably comfortable with the end of life as a family doc. I am disheartened when patients and/or families insist upon invasive, aggressive care that I know to be futile. I've talked about hospice and end of life wishes with patients and families numerous times. But, maybe, obsessively sifting through charts and worrying over what others think of me reveals that I'm not really that comfortable with death. I am, frankly, ashamed of the hubris I must possess to assume that the end of a patient's life has much of anything to do with me at all.
Maybe that discomfort's not so bad, then; it certainly reminds me that I am only human myself.
Tuesday, January 8, 2013
Wednesday, December 26, 2012
Weekends & Holidays
Ever since medical school, I've found rounding in the hospital during the weekend and/or holidays frustrating.
You'd think that hospitals would be 24-7 kind-of places, right? I'll grant that patients certainly stay in the hospital during weekends and holidays. Nurses and doctors attend to them, meals still come, rooms are still cleaned. However, many of the important people who work in the hospital don't work during the weekend or a holiday unless there's an emergency.
Let's say that you're a patient admitted with chest pain. Your initial testing was okay - you're not having a heart attack right this second - but the docs want to make sure that you're not the verge of having one. Your medical team decides you need a cardiac stress test.
Hope you didn't come in on a Saturday night, though, because your hospital doesn't do stress tests on Sundays. You'll spend an extra night in the hospital waiting for that stress test (or echocardiogram or non-urgent cardiac catherization) Monday morning.
Lest the cardiology department feel singled out, here are other common hospital procedures that are rarely done on the weekend, especially Sundays (with the exception of life-threatening conditions, where someone must come in from home to perform the test/procedure):
MRIs, CT scans, ultrasounds
Colonoscopies/EGDs/ERCPs
Most non-urgent surgeries
Social work assistance with transfer to rehab facility or nursing home
Financial aid officers to set up discharge care plans for uninsured patients
I understand that all of these procedures require people who are less well paid than docs to come in and assist or perform them. I also understand that work-life balance is important for health care workers.
Staying an extra 24 hours in the hospital, however, is not a low-stakes proposition for patients. It's expensive, for one thing. An average night in a US hospital runs from $3000 to $4500, depending on who you ask.(1) And, although many are working to eliminate medical errors, hospitals still remain rather unsafe places to stay unnecessarily. Preventable medical harm kills upward of 100,000 people a year in the US. (2)
Some hospital workers who must be there 24-7 include the nursing staff. They manage to create schedules that fairly divvy up weekends and holidays, exchanging time off during the week. Creating schedules for hospital workers that maintain a constant presence - regardless of weekends or holidays - has been a way of life for nurses for years. It's high time that the rest of us followed their example.
Until every service that's available on a Monday is available on a Sunday, though, our patients will see that having our weekends and holidays off are worth more to us than providing them with safe, cost-effective care.
(1) http://meps.ahrq.gov/mepsweb/data_files/publications/st164/stat164.pdf, http://healthpopuli.com/2010/11/23/luxury-goods-a-hospital-stay-in-the-u-s-a-big-mac-in-switzerland/, http://www.kaycircle.com/What-is-the-average-cost-of-a-Hospital-Stay-per-night-in-2010-Price-Range-of-staying-in-a-Hospital
(2) http://safepatientproject.org/safepatientproject.org/pdf/safepatientproject.org-ToDelayIsDeadly.pdf
You'd think that hospitals would be 24-7 kind-of places, right? I'll grant that patients certainly stay in the hospital during weekends and holidays. Nurses and doctors attend to them, meals still come, rooms are still cleaned. However, many of the important people who work in the hospital don't work during the weekend or a holiday unless there's an emergency.
Let's say that you're a patient admitted with chest pain. Your initial testing was okay - you're not having a heart attack right this second - but the docs want to make sure that you're not the verge of having one. Your medical team decides you need a cardiac stress test.
Hope you didn't come in on a Saturday night, though, because your hospital doesn't do stress tests on Sundays. You'll spend an extra night in the hospital waiting for that stress test (or echocardiogram or non-urgent cardiac catherization) Monday morning.
Lest the cardiology department feel singled out, here are other common hospital procedures that are rarely done on the weekend, especially Sundays (with the exception of life-threatening conditions, where someone must come in from home to perform the test/procedure):
MRIs, CT scans, ultrasounds
Colonoscopies/EGDs/ERCPs
Most non-urgent surgeries
Social work assistance with transfer to rehab facility or nursing home
Financial aid officers to set up discharge care plans for uninsured patients
I understand that all of these procedures require people who are less well paid than docs to come in and assist or perform them. I also understand that work-life balance is important for health care workers.
Staying an extra 24 hours in the hospital, however, is not a low-stakes proposition for patients. It's expensive, for one thing. An average night in a US hospital runs from $3000 to $4500, depending on who you ask.(1) And, although many are working to eliminate medical errors, hospitals still remain rather unsafe places to stay unnecessarily. Preventable medical harm kills upward of 100,000 people a year in the US. (2)
Some hospital workers who must be there 24-7 include the nursing staff. They manage to create schedules that fairly divvy up weekends and holidays, exchanging time off during the week. Creating schedules for hospital workers that maintain a constant presence - regardless of weekends or holidays - has been a way of life for nurses for years. It's high time that the rest of us followed their example.
Until every service that's available on a Monday is available on a Sunday, though, our patients will see that having our weekends and holidays off are worth more to us than providing them with safe, cost-effective care.
(1) http://meps.ahrq.gov/mepsweb/data_files/publications/st164/stat164.pdf, http://healthpopuli.com/2010/11/23/luxury-goods-a-hospital-stay-in-the-u-s-a-big-mac-in-switzerland/, http://www.kaycircle.com/What-is-the-average-cost-of-a-Hospital-Stay-per-night-in-2010-Price-Range-of-staying-in-a-Hospital
(2) http://safepatientproject.org/safepatientproject.org/pdf/safepatientproject.org-ToDelayIsDeadly.pdf
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