We need a new model

It’s common language now to say that we have one of the best health care systems in the world, but some of the worst access to care. In my mind this is true, but it’s missing the point. In thinking about healthcare as a business saying that we have poor access to care is basically saying we have a great product, but our potential customers due to various reasons can’t figure out how to use it. We take a passive approach when we start placing the burden of our failing system on access to care alone. Our model is complacent with the concept that the patient will come to us. We commonly accept the idea that our patient’s will negotiate their own insurance, co-pays, and the myriad of other complexities involved in acquiring and utilizing healthcare. In short, we have the potential to offer a brilliant product, but we over rely on our customer to do all of the work to reach what we are selling, and often through a web of tangled bureaucracy.  Our access to care is indeed terrible, but poor delivery is equal to blame. What are we doing as a medical community to offer new innovative ways that would allow our patients not only quicker and more efficient care, but a delivery mechanism that takes the burden of procuring healthcare off patient and more on the infrastructure?  Read more

The white coat turns black

If you think about it there is a high probability that you will someday die in the ICU. Unfortunately my month, notably my last two weeks became well known for the record setting 14 patients we celestially discharged. For the majority of these people death was inevitable, their last few breaths before a massive heart attack just happened to be on the ramp of the hospital after leaving some clinic appointment resulting in them being intubated just in time to buy a few more hours on the unit. But even in the face of futility there is still a feeling of guilt and sometimes overwhelming hurt when this news must be broken to a family sitting calmly in the waiting room. Read more

Settling In

 

Once the initial shock of foreign dials and tubes wore off I was starting to fall into the rhythm of how the unit works. In reality a lot of it is pretty cookbook, and I was getting better at baking. There are only so many paths to walk down when someone comes in with respiratory failure, or septic shock. As I caught on I really started to enjoy it. The MICU is just as busy as the CCU, but far more enjoyable because in my mind its real medicine and not a bunch of referencing to some obscure cardiology study to guide treatment. I started making decisions about treatment by just using common sense and wasn’t chastised for it, sounds like that would be simple enough to understand, but on the CCU I felt like I needed to be well versed in the “I went to third grade” trial before I could confidently tie my shoes without fear of punishment. Settling In

Intensive Confusion

 

The difference between the ICU and the medicine wards is sort of like the difference between making a microwave dinner and preparing a five course meal from scratch. What became painfully obvious to me the first day on the ICU is that I’ve gotten really good and pushing the buttons on the microwave, yet I’ve never had a cooking class a day in my life. Read more

Not a Cardiologist

Is the answer to the question what I will be when I grow up! Besides last month the last few months haven’t been all that bad. I was on Neuro for a month and then GI, my role was somewhere along the lines of a med student with the ability to write prescriptions. I got weekends off, and for the most part was home well before 5pm. Nothing to complain about at all, in fact I was starting to slip away from the reality that intern year is supposed to be hard. Read more

Its all fun and games until people die!

If the CCU wasn’t bad enough the way call was set up was down right dangerous, and everyone knew it. If I only to admit CCU patients all night and tend to existing patients it would be more than manageable. The issue was I also had to oversee the existing ICU patients and admit to the ICU all night as well. The ICU patients were ridiculously complicated. When the nurses called me about some really sick patient I had never met all I had to go on was a couple lines that were signed out to me from the other interns about that patient. For several of the calls the ICU was almost full, and the ICU pager did not stop going off, thankfully I wasn’t alone there was one other senior resident on call with me. I typically called them for just about everything. I could deal with a patient having a headache in the middle of the night on medicine, I couldn’t handle a patient whose blood pressure was 70/30 maxed out on a vasopressor drip and a failing heart, while my only piece of information I had was a little sheet that read “may become hypotensive”. Read more