Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Tuesday, April 29, 2003
    Day Two

    In medicine, to "diurese" means to give a medication - a diuretic - that forces the kidneys to absorb less fluid during the process of filtering urine than they ordinarily would. The result is that the patient urinates more and loses fluid - a useful thing if one is in congestive heart failure or is otherwise fluid overloaded.

    In the rough-and-tumble world of inpatient medicine, diuresis has another meaning; it is used to describe the process of lightening one's inpatient service by discharging patients from the hospital, which is exactly what I am trying to do. I am aided in this process by a case manager who is as sharp as a tack. She was on me as soon as I walked in the door of the hospital yesterday with suggestions about which patients needed physical therapy consults (a prerequisite for nursing home placement) and which families I needed to open negotiations with regarding placement for their loved ones (to go home or to the nursing home?) As I was frantically trying to find my feet with sixteen patients at two different hospitals, I was initially annoyed, but today I see the benefits. One went home today, two and possibly three are going home tomorrow, and the IV antibiotics and home care are all lined up.

    I guess what I'm trying to say is, this isn't as bad as it was in January.

    I had an interesting encounter today down in the radiology department - ran into a guy who used to be a member of our group and left earlier this year to open his own practice. (Among other things, he got tired of the bimonthly staff meetings or "Monday Night Meetings" which we've had ever since the group was founded.) He was full of questions:

    "Still going to those Monday night meetings?"
    "Are you still getting bombarded with patients?"
    "How's the hospitalist program going?"

    I asked him how he was doing. He actually appeared upbeat, almost bubbly, which for this guy is a rarity. I've always gotten along with him fine, but he had a reputation as a grumbler.

    "I've been happy every single day since I started," he said. These are words I would not have expected to hear. "I mean, there's the stress of getting an enterprise like this off the ground, but I work half days and I'm making money after three months. There is money to be made in this business!"

    I asked him some questions about billing and insurance. He doesn't take Medicare or Medicaid, but he does take certain insurance plans and he even has some cash patients (where the hell did he find those?) I believe some of his medical group patients followed him to his new practice, but he must be getting referrals from someone.

    I wished him well. This seems to suit him and I'm sure he'll be successful. During the rest of the afternoon I wondered, as I sometimes do, what it would be like to have my own practice. Would it be possible to do it and make money? Maybe, but I'd have to work a lot harder than I do right now and I'd rather not. I'm talking about things like paying office rent, conforming to OSHA regulations, hiring and firing employees and setting up a 401(k). Plus, I like being able to duck down the hall for a curbside consult with one of my partners (especially the specialists) or just for a chat. Solo practice, I think, would be awfully lonely.

    No, I'm a groupie, and I'll stay one.



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