Managed Health Care

The following is a direct cut and paste from Houston’s Clear Thinkers blog. It was written by a health care practitioner to the author of the blog.

I’m down to ten days left there, and those days can’t go by fast enough for me.
The average number of admissions in a weekday day shift (7 a.m. to 7 p.m.) is 12.

We had 23 yesterday.

When you take the standard estimate of an average of 75 minutes necessary to complete a new patient admission to the hospital — with the attendant patient interview and data collection, physical exam, review of lab and x-ray results, formulation of treatment plan, preparation of admission orders, and dictation of the official patient history & physical for the medical record — the amount of work requested from our hospitalist group yesterday was 13+ hours over average. This is more than another full-time equivalent doctor, yet we can’t persuade the national hospitalist company managing the hospital to provide any more help for us.

As a consequence of the barrage of admissions, I did not complete my “morning” rounds on existing hospital patients until 6 p.m.  There were a couple of patients who could have been discharged from the hospital yesterday, but by the time we got to them, it was too late in the day to discharge them (area nursing homes won’t take transfers after 2 p.m.).

As you can imagine, this type of delay causes longer length-of-stay and more expense for the system.  And this does not even begin to address the mistakes in care that may have been (or more likely WERE) made due to all of us rushing around as if we were in a 12-hour long fire drill.

It’s a bad way to practice medicine.

Contrast this to my new situation, which is a hospital-administered program. They believe in and adhere to the notion that the risk is high that patient care is likely to suffer once a doctor is required to see more than 15 hospitalized patients per day. Inasmuch as they don’t have the heavy administrative overhead that national hospitalist companies are required to service, my new hospital can allow their docs to work at a more controlled pace and still make ends meet.

Ten more shifts and I’m gone.

Thanks for letting me vent.

That’s what we have waiting for us. There are a finite amount of health care resources available at a given cost in any “system”. And the management of those resources is what causes problems. Let’s face it, there are about 304,000,000 folks in the US and there just aren’t enough resources to treat everyone if they all get sick. Government mandated health care insurance for everyone cannot possibly encompass an acceptable quality of care. It’s the same with HMO type programs. People complain all the time about the crappy care they get in an HMO. But it’s more “affordable” than conventional private care. Better to wait weeks (months?) for an appointment with an assigned doctor who only has enough resources to give 9 minutes to assess, diagnose, develop treatment and move on? Bah!


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