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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    Thursday, June 24, 2004
    Thursday Afternoon

    Set the scene:

    It's my half day. Our Medical Director is out on vacation, as are many other members of The Firm. I, Dr. Alice, your host, have been nominated Acting Medical Director because all of the Usual Suspects who would normally cover this job are also on vacation. This means, among other things, that I have been put in charge of STAT insurance referrals.

    I have no idea what the hell I'm doing.

    Here we go:

    Dr. Alice picks up a chart and reads the message. Message says, [Patient] states her insurance has changed so she needs another prescription called in for her [anti-depressant.]

    Dr. Alice:
    I hate you.

    Dr. Alice picks up phone and calls refill to pharmacy because her medical assistant has left early (after all, it's Dr. Alice's half day!)

    Secretary appears with armful of faxes.

    Dr. Alice:
    What are those?

    Secretary, nervously: These are from UR [Utilization Review]. She called a few minutes ago and said you had to review these.

    Dr. Alice flips through pile of faxes, most of which consist of requests for breast reductions and extensions of physical therapy with reams of documentation attached.

    Dr. Alice:
    Oh shit.

    Details of chart reviews and decisions omitted, due to risk of stupefying boredom. Assume decisions are made.

    Page on telephone intercom:
    Doctor, it's Generic Geriatric Nursing Facility. One of Dr. X's patients was just admitted. [Dr. X is on vacation and she's in my call group.] Who's going to follow the patient until she gets back?

    Dr. Alice quickly consults call schedule, which is hanging on the wall: Dr. Y is on call today, so he gets the patient. (Standing rule. It's the law of the jungle.)

    Voice on Intercom: Well, uh, should I tell them to call him?

    Dr. Alice: No, it's better if I do it. I'll leave a message on his voicemail and then run like hell.

    [Tinny giggle from intercom] They need admission orders verified. Will Dr. Y do it?

    Dr. Alice, in resigned voice: No, I will. (No need to add insult to the injury I'm inflicting on Dr. Y.)

    Orders verified. Message left (very apologetically) for Dr. Y.

    Dr. Alice returns to her previous activity of leaving messages for patients; calls random patient, gets answering machine message consisting of 45 seconds of rap music.

    Dr. Alice:
    I hate you.

    And so the long day wore on.



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