Archives for May 11, 2008

The humor behind health care reform – Medical Economics

Dr. Leap is getting even more famous!

The humor behind health care reform – This doctor’s tongue-in-cheek rallying cry is steeped in undeniable truth. – Medical Economics

I was buried in a sea of charts when a colleague joined me in the physicians’ lounge. We joked about our frustrations with paperwork and patients, while somberly agreeing that medicine’s in a bad way and physicians are more and more dissatisfied.

At the same time, we recognized that many of our problems are self-induced, stemming from doctors’ tendency to ignore fundamental truths. So I set out to compile a list of what we need to remember—truths that often go unnoticed while physicians utter empty words about professionalism, duty, and healing.

The Protestant Reformation began with Martin Luther’s theses. I’m not Luther, and my “undeniable truths” may not be nailed to a church door. But they could be the stirrings of a healthcare reformation.


Go, read, and comprehend!

Transfers due to Incompetence

Recently, I and my colleagues have taken a lot of transfer calls that have, as their basis, professional incompetence.  Allow me to explain, and then to ask a question.

We’ll get a call from an ER doc with a patient who’s stuck in the middle of a situation: their ED patient has an emergency requiring specialty treatment, they have a specialist in said speciality, but said specialist ‘doesn’t feel comfortable / hasn’t done in years’ the procedure the patient needs, so we’re called to get the patient to a specialist that’ll take care of them.

As a description I’ll tell one bowdlerized tale to give the flavor: patient with an open femur fracture.  Sending hospital does have an orthopedist on call, but “s/he only does spines, and they doesn’t feel comfortable doing this”.  (This happens with virtually all specialties, I’m not singling out ortho, just using them as an illustration of a general problem).

So, yes, medically we can take care of this patient, and medically we accept the transfer; when I talk to admin, I make sure they know all the facts, and then I make sure we do the right thing for that patient, and that’s to bring them to us.

Here’s my question: besides an EMTALA complaint (which the hospital reportedly files a lot of, and reportedly come to nothing), is it time to start reporting this level of professed incompetence to certifying boards?  I would presume a Boarded Orthopedist would be able to take care of an open femur fracture as part of both routine training and certification (and I’d bet they’re credentialed for that procedure at their hospital); if they then profess incompetence in caring for that injury, wouldn’t their certifying board like to know?

What say you, physicians?  Report, yea or nay, and if not, why not?