I got a page this weekend from a hospital case manager. It seems that two of my hospital patients don't meet inpatient criteria, and according to the bean counters' manual they should be sent home. The problem is that both of these folks have positive stress tests and are scheduled for heart caths, but can't have them until Monday because the cath lab only opens on Sunday for emergencies.
I told the case manager (very politely) to put her guidelines where the sun don't shine. Maybe my fuse is a little short because I am reviewing a case for a lawyer right now of a patient who had a negative stress test (despite a history of exertional chest pain), and went home and had a cardiac arrest.
I feel sometimes that doctors are like Han Solo and Princess Leia and Luke Skywalker trapped in the starship garbage unit with the walls closing in on them: on one side the need to contain costs, on the other the need to practice medicine for the benefit of the patient we're responsible for.
Does anybody wonder why doctors are cutting back their hours, giving up private practice and retiring early?
Stella Fitzgibbons MD
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