Wednesday, August 09, 2006

Unassigned Call:

My wife and I met the year before she entered med school and got married 2 years into med school. I observed her 9 years of post graduate education and while she was learning to be a doctor, I was learning about the process of becoming a doctor and the kinds of people willing to go through all that.

It's amazing to me the amount of really goofy information and ideas about docs and hospitals and how the whole thing works that float around out there. Some of the funniest to me have come from my own family and I'm sure that they will provide fodder for many a post in the future.

A really sad story that I still hear thrown around is that if you show up at the ER with no insurance and no money that they can refuse to treat you, or that they somehow give you sub standard care because you have no way to pay them. While I'm sure there are individuals out there in the system that would be willing to skimp on the care of one who cannot pay, the system as a whole most certainly does not do this.

If you come into the hospital and you already have a doctor then it's likely that your doctor will be assigned to be your primary physician while you're there. They may then consult various specialists about your specific problems. But having a doc who knows a little about you calling the shots makes a huge difference to the quality of the care that you'll get. If you dont have a doc at that hospital you'll likely end up the responsibility of someone who is a specialist in the area that they think your main problem is. Just who gets you in that situation is probably hospital specific too, some have these shiny new hospitalists that can do that and handle managing your care and your visits by the various specialists. Getting a new patient that you know nothing about as an admit to the hospital can be a huge amount of work. The doc in charge of you has a LOT of reading in your chart and study up on you to do. Then interviewing you and getting an much recent history from your as possible and figuring out whats going on with you that brought you to the hospital (when a doc asks you "what brought you to the hospital tonight?" please dont say "the ambulance", the next question is usually something like "and why if that has been happening all week did you decide to come to the ER at 3am on a Saturday?")

Yesterday my wife took part in what the hospital calls "Unassigned Call." All the docs in the hospital take part in this rotation from the loftiest neurosurgeon to the lowliest internist. (no offense in Internists, just needed someone for the opposite end of the example ;) What happens to someone with no money and no insurance and no way to pay is that you get assigned to this doc to be your primary. Every couple of months it's my wife's turn again to pick up charity patients. It spreads the financial and temporal pain around a bit.

It's once these folks leave the hospital that their care suffers. The followup rate is very frustrating for my wife, who can't get them to come back to appointments with anyone. There are often family and mental issues that are not conducive to their being able to care for themselves properly. In the case of those that stay my wife's patients that means showing up for dialysis appointments regularly and taking a lot of meds. So she calls Psyche consults and recommends them to counseling and gets them the names of shelters or other groups that can help them out, and doesn't see them again until they are so sick that someone again calls an ambulance for them and we start over.

So lets put a stop to that particular story. Nobody is turned away at the door.

Now Sesame Street is ending and the kids need some breakfast so I'm off for some fatherly duties...


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6:26 AM  

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