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Notes on the Passing Scene…from the Hospital

[Submitted by Doc Holliday]

Ready to take a break from all politics, all the time?  The great Thomas Sowell occasionally pens a column where he comments on random events about him–mostly political and economic, of course, given his status as one of the great economic minds of our time. In that spirit, let’s take a tour around the hospital.  We’ll stick to medicine, mostly, with the random thoughts that pass through my head as I do my rounds.

Is it a bad thing that my favorite patient is intubated, sedated, and alone?

The purpose of the ever increasing documentation requirement is NOT to improve the quality of care (which is what is always claimed) but rather to maximize the opportunities for insurance to deny payment.

In that same vein, if the insurance companies are looking to deny payment, the government through medicare/medicaid is also looking to intimidate the doctor into undercoding, with the ever increasing documentation being used to maximize the opportunity to prosecute physicians/hospitals for “fraud”.  This saves them money.

NO ONE in government will ever admit the above statement is true.  EVERYONE in medicine knows it is.

Often times the families are far harder to take care of than the patient.

I am always amazed by family members who will ask what I think is wrong, listen to my reply, and then say, “I don’t think that’s what it is.” Really?  Then why are you here?

Most of the problems I see in people who are not of the age to be collecting social security are due to self abuse with cigarettes and alcohol and drugs, with random misfortune being much less frequent.

Nurses are wonderful people.  Nurses are some of the most irritating people on earth. These two statements are not contradictory.

It is a given in medicine that as soon as you leave the hospital, someone will call asking you to come see a patient.  It is a 100% guaranteed event, as certain as the sun rising in the East.

If you pretend to be unable to pronounce or remember the name of your favorite narcotic, you are an addict.

It’s called “Dilaudid.”

It may not be apparent, but hospitals and doctors are in a continuous state of conflict –the suits who run a hospital see only numbers, whereas the doctors see medical problems that must be addressed.  This leads to many arguments, dumb ideas, and blank stares of misunderstanding.

There are no old ER doctors.

Case managers have the worst job in the hospital.  They have to try and please the patients, the families, the doctors, the insurers, and the hospital–all at the same time.  You could not pay me enough to do their job.

Computers are great, until they crash.  Then they are piles of electrically charged slug dung.

I hate cancer.  Of any sort.

You never want to be the interesting patient.

Americans are time obsessed.  “How long do I have to stay, Doc?’ is not the correct question.  There is no time in a hospital.

The correct question is “What criteria need to be met for me to be discharged?”

Be nice to your nurses, ancillaries, and doctors.  You will get perks.

Assholes get taken care of, too.  The experience is just effective, rather than pleasant.

Living wills last until the first time a patient can’t breathe.  Then they are thrown out the window.

If you are having a baby and bring a birthing plan to the hospital with detailed instructions for your all natural child birth, you will have a Caesarean Section.

GI bleeds have an unmistakable odor. Like copper burning.  You’ll never forget it.

The opioid crisis was started by misinterpretation of a small observational study that was taken, twisted, magnified, and used to guilt trip doctors into the medical version of “virtue signaling”  by proclaiming pain to be the “5th vital sign”.

If you don’t like your doctor, change doctors.  We don’t care, and would rather not take care of you if you’re not happy with us.

I would rather take care of ICU patients than any other patient.  The feedback is immediate, or nearly so.  They either get better, or they don’t.

Morphine and Lasix may be two of the best drugs ever invented.

90% of people who claim to be allergic to penicillin–aren’t.  But we’re not going to test it.

Do not lie to your doctor.  I do this all day, every day, many, many, many times a day.  Your lies stick out like a glaring red light. And if you do fool me, it could get you hurt or killed.

Nothing makes me more upset than coming into a case where someone has had to have a limb amputated due to diabetes, and putting them on a tiny dose of insulin causes their sugar to normalize–which means they never took care of their diabetes. and the amputation never had to happen.

Immunizations are one of the great triumphs of human medicine.  Their success is the only reason anti-vaxxers can exist–because none of them have seen what happens when a child gets polio.

Normal temp is 98.6 +/- 1.8 degrees Fahrenheit.  So 96.8 to 100.4.  Don’t tell me you have a fever at 99F because you are normally 98.0.  No.

Psychiatrists are the doctors who are closest to their patients.

Winter is coming. Get your damn flu shot.

Doc Holliday

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