He came in and stood by the end of the bed, introducing himself as the new supreme dictator of all imminant decisions regarding my body.
I stared back, not quite sure that I wanted to entrust all of that to someone that I'd known less then fifteen seconds. Really, I just wished my own doctor were there to streamline the entire process and not leave out some critical piece of information.
"Sooo-are you keeping to your diet?" he asked, grabbing my big toe and quickly running the tuning fork up and down both legs, leaving both legs doing whole-limb muscular jumping jacks in its wake.
"No."
"Whyever not?" he asked, the concern lines deepening across his forehead. "It's especially important, if you want to live fifty+ more years."
"Probably because I've spent the last 18 hours in post-Red Lobster purgatory and its rather hard to stick to a diet when its coming out both ends."
"How about your blood sugars...how are doing?"
"Status quo. Mid 100's. Surprisingly stable."
"Well, we'll be putting you on a sliding scale when you're admitted, ok?"
The situation rapidly esculating towards complete disaster, I feared those words above all others. I use an insulin pump...a $6,000 system vastly superior and more precise then the simple sliding scale.
"Absolutely not. I use an insulin pump, and I'd like to stay on it."
He blinked twice, frowning at this unexpected insubordination. "But we do it this way for everyone."
"Sliding scales have never worked for me, and I'm much prefer to stay on my pump." Bravado facade, quaking on inside that he wouldn't like it and leave me to rot/die in the Emergency Room. But he left, without saying another word. Crises averted, temporarily.
Later, up on the floor and having my blood sugar rechecked, the nurse informed me that Dr. Masochist wouldn't permit me to stay on the pump if my blood sugars went hyperglycemic. Fortuantly for me,the zero intake of calories made that not an issue so he couldn't make good on that threat. Never another word about that..and two days later I was well enough to be discharged.
That was a first ever contact with a hospitalist, and I didn't score any brownie points but maybe I helped him understand that some things, do need to be adjusted to fit the patient's needs.(its not a one size fits all deal)It's my opinion that hospitalists are sticklers for protocol.(maybe they have to be)
Tuesday, February 3, 2009
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I don't mind if a mentally capable person with an insulin pump manages his/her own diabetes. Just don't sue me if anything goes wrong.
-Steve
Just don't sue me if anything goes wrong.
Ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha!!!!!
You also believe in unicorns and fairies, don't you?
You did the right thing. Excellent job.
From this patient's perspective ... hospitals, hospitalists, and living with chronic illnesses ...
About 6 years ago, when things went badly wrong, I had no qualms about going to the emergency room, knowing that my physician, who already knows me and my conditions, would do the right thing by me once I was admitted. And he always did.
Not long afterward, I was shocked to discover that I would be followed by a fellow I'd never seen before, and that with the exception of a brief phone call to my PCP, who had no idea about my issues with the exception of what I presented to the ER with. The experience was a nightmare. I had never even USED the word "continuity" before that ...
Since then, in spite of my best efforts, I've been an inpatient several more times. My hospitalists have barely spoken English (no exceptions), and we had some very wide and frightening communication gaps. Most of the time, my PCP had no idea of what actually was done while I was there.
Now, I push the envelope as far as I can. I will not go to the ER as long as I'm conscious, even when I know I should. I would really rather take my chances at home, and see my PCP in his office later ... and hope he doesn't SEND me to the ER. :o(
When a person is at their sickest is exactly when they want to deal with someone they know... and who knows them. We don't see you people in the same light as we see waiters in a restaurant ... "any waiter will do as long as s/he can accurately bring back the goods" ... the entire idea of having your own PCP is not only that you've chosen someone you can relate to, but there's also a trust, a two way relationship there. You are not interchangeable. That trust might have been earned and worked on for years ...
This is going to sound negative, but I honestly can't help it: if more hospitalists remained/went into PCP careers, they wouldn't be needed as full timers in hospitals.
I've heard all of the arguments about hospitalists being better able to deal with the "very sick" since that's what they do all the time ... but a patient is not just a sickness ... and when you see them at their worst in a hospital, you need to remember that the other aspect of themselves, the one that invested time and effort into developing a relationship with their own PCP is also part of the equation - a big part.
This is simply an ongoing and worsening example of the depersonalization of medicine in the US. We have some the of best medicine in the world, but the delivery method is in a coma. Sad ... and frightening.
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