A New Year and Some Resolutions (For My Patients)

I spent New Year's Eve with my hubby in Niagara Falls listening to a great concert by Roger Hodgson and then watching the fireworks over Niagara Falls. All throughout the course of the evening, my hubby kept asking what my New Year's resolutions would be. I kept trying to think of things I would change for the next year: read more research journals, study harder, try to be nicer to my patients, etc. Then I realized that the majority of my gripes are due to some of the things that patients are wont to do. So, tongue-in-cheek, I offer the New Year's Resolutions that I thought of for my patients so that I can become a better doctor in the next year...

1.) Bring a list of your medications. When your blood pressure is 210/104, and you tell me that you didn't take your medications this morning, but you're on something for blood pressure but not one type because you're allergic to it, it would really help me to know what class of medication you're allergic to or I might give you something that might kill you. And, don't say, well "it's in the computer" because we are not linked to every clinician's office in the area. If you don't know your medication list, at least know the last pharmacy where you bought your meds because we can sometimes call and get the information. Oh, and if you're supposed to be on these medications but haven't taken them in a while, that's important too. Yeah, just a little.

2.) Don't come to the E.D. if you don't plan on staying. I had two patients at risk for a major heart attack leave because they "got tired of waiting for their room." I had another patient with a severe septic infection that will become life-threatening if not treated leave because the family didn't like how long it took for them to get a CAT scan. We spend an incredible amount of time and resources making sure that patients are stable before they can be sent upstairs. That's not including the amount of time spent on the phone arranging for consults, arranging for admission, ordering tests for follow-up, etc. In the real world, aka "people with insurance not on Medicaid," the bill for the E.D. visit would not be honored by the insurance company for the patient who leaves AMA (against medical advice) or absconds (leaves without being seen), and the patient would receive the bill and be expected to pay for it. Since the majority of our patients are under Medicaid, the hospital ends up eating the bill. Not to mention the time I spent on you was time I could have spent helping someone else who might really need it.

3.) Don't hospital shop. If all of your care has been at one hospital, then you decide you don't like the way your care has been managed, don't keep changing hospitals hoping for a better experience. Some of our hospitals are connected by EMR's (Electronic Medical Records), but most of them aren't. Also, at ECMC we can check the other hospital system but not vice versa. The great thing about being in the residency program is the ability to call your colleague at another hospital to ask them to check the medical record for a patient. But, it takes time, both mine and theirs.

4.) Don't lie. We jokingly call this the "House Syndrome" in honor of the House, M.D. TV show. According to House, "everyone lies." If you don't tell us about your 12 pack a day drinking habit, we might admit you to the hospital only to have you go into the DT's 3 days later. If you don't admit to your cocaine habit, we might give you a beta blocker that will lead to a fatal arrythmia. So, just admit it. The truth will come out eventually.

and, finally,

5.) Say "thank you." My hubby was bagging on me a little bit telling me I was remembering the bad and not acknowledging the good. So Cheers! to all those patients that sincerely appreciate the help we give. Cheers! to the families that shake our hands as we walk out the door, or as their loved one is being transported up to the floor. Cheers! to the patients and family members that take the time to send a card or acknowledge us in the patient care surveys. Thank you!

I wish everyone a HAPPY and PROSPEROUS NEW YEAR. It promises to be a most exciting one!!