Monday, June 29, 2015
There is nothing truly original in the world.
I ease off the gas pedal of my already outdated hybrid Prius.
My job will eventually fall prey to a computer named Watson. My practice will be gobbled up by the nearest Goliath medical center as history scoffs at the arthritic physician bending over a doorbell with leather bag in hand.
There is no flash of glory here. No smart technology.
The echo vibrates through cracks in the sidewalk and drags me unwillingly forward to the unkempt house at the end of the block.
Adapt or perish.
I open the door without knocking and find a decrepit figure slumped into a reclining chair in front of the television. His car keys were long ago taken by some relative or another. He waits for nothing in particular. Scraps of food have been left on the side table by a home health aid.
There are memories of being gainfully employed. Road trips across barren lands and such. His son is now grown up and makes decisions on his behalf. A nursing home is a far safer environment than this empty old house.
My visits to the end of the road are numbered.
Old is replaced by new.
Utility and functionality apparently are relative terms.
And by and by something is lost.
Posted by Jordan Grumet at 5:59 PM
Thursday, June 4, 2015
My patient later told me that the exam was exhaustive. The PA, who incidentally graduated school the day before and had never seen an actual patient as a licensed practitioner, poked and prodded the ninety year old woman for over an hour. He asked her about drugs and sexually transmitted diseases. He examined every joint and performed a Babinski test.
A few days later I received a call from him. He tried to leave a message with my secretary, but I intercepted the call.
He had two recommendations. He thought I should do a better job of addressing the patient's knee pain. When I asked if he thought it was a result of her polymyalgia, rheumatoid, or osteoarthritis, he had no idea. When I mentioned that the pain had been treated in the past with various medications (and physical therapy) and the patient had stopped them all due to fatigue (even Tylenol), he was surprised. When we discussed that she was in the hospital multiple times for pain control before I met her, and now had avoided hospitalization because of better symptom control, he said he was unaware.
His other recommendation was to start the patient on Detrol for overactive bladder. He, of course, had no idea that her urologist had tried the same thing a few years back and she had become dizzy and broke her hip.
It wasn't the poor PA's fault. There was no way he could have known what I gleaned from a year's worth of hospital, nursing facility, and home visits.
He just didn't know the patient as well as I did.
Which, of course, brings us back to the insurance company. They believe that complex problems can be solved with simple solutions.
Just get some PA to go over there and make recommendations.
Those dumb physicians aren't getting the job done.
Posted by Jordan Grumet at 1:45 PM