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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    Saturday, June 11, 2005
    The Transfer Lambada

    Yes, I did the Forbidden Dance this weekend... with any number of physicians and administrators. One may have an almost infinite number of partners for this particular dance, as we shall see. This is how it goes:

    I got a call tonight from a physician at what we will call Valley Hospital. (Not its real name.) He told me that they had one of our patients there with a Tylenol overdose who needed a transfer "because we don't have liver transplant facilities" and then proceeded to read off a list of labs that were not that abnormal. My mental response was "Because you're a lazy shit who doesn't want to be saddled with an OD." I may be misjudging him, I hasten to admit; I can't remember enough about Tylenol [aka acetaminophen] overdoses to know how soon somebody may turn on you and have their liver go straight into the toilet. So I asked further questions regarding insurance (a valid question because The Firm's call schedule for hospitalists is split into three groups because we're so freakin' big; we divide by insurance for billing reasons). The patient's insurance coverage meant that he/she would go to Hospitalist Group A - I am in another group.

    So, first question: does the patient's hospital, Great Big Tertiary Hospital, have a bed available? My first thought was no, because the patient would require cardiac monitoring and those beds are hard to get, but I called the transfer department to see. Wonder of wonders: there WAS a bed available. Okay. So then I called the doc in charge of Call Group A for that particular evening. I had to call him because he would be the admitting physician for the patient, I would not, so therefore he would have to call back the doc at Valley Hospital to confirm acceptance of the patient. But Doctor A called me back and said, "Oh, if you've talked to the doctor at Valley Hospital, that's fine. Just let me know when the patient gets here."

    So I'm accepting the patient by proxy? When did that start happening?

    Be that as it may. I called back the transfer department, called back the Valley Hospital doc, authorized the transfer and now all we have to do is await the arrival of the patient.

    Which will probably happen about two in the morning.

    And I will probably get called again even though I have nothing to do with it. Oh, well, at least I'm getting paid for this.



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