Friday, May 25, 2018

DO THE RIGHT THING

        I enjoy medicine -otherwise with today's demand on medical practitioner for non medical things and things that do not help patients , I would have stopped doing medicine..I also watch news and the political commentaries. In my life time I have never seen such a divide.It almost reminds me of OJ court trial. The conclusion drawn are diagonally opposite. I wonder if they were watching same proceeding or not . But I often get the same feeling when I see patient. This is not new .In past it has happened to me that I was asked to 'clear' a patient for surgery and I thought that the patient was terminal. He was thought to have incarcerated hernia and needed surgery . He was seen by hospital MD , surgeon and cardiologist and kidney specialist . When I saw the patient , his hernia was reducible and nor incarcerated , his heart was pumping at 10 % and he had kidney failure and he had water in lungs .Not only he DID NOT need surgery , he could not have SURVIVED THE surgery. So when I told this to the daughter , she was surprised as OTHER doctors had cleared him . I went see her again and showed her the labs and the heart reports and the chest X- ray .We made him DNR and he dies in 24 hours . This brings me to today/s story . 
       When I was passing in the hallway of the hospital , I came across an Indian male , who mistook me for some one else . His wife was admitted and so I hello to them . I came to know minimal things about her medical problems . I told them that I will let the physician -that they knew , and from behind mistook me for him -know that she is admitted. After about 3 days or so I got a call from hospital . The nurse told my secretary that I was to see a new consult . My office took the information . I was busy with office patient and then I got 2 text message to call the nurse . So I called . The same lady that I had seen socially 3 days ago , was the new patine. She was short of breath and they wanted me to see her . She was so bad that the nurse called me on my cell phone twice. I had no call from any other doctor -not even the Hospitalist MD. The nurse had called Rapid response team twice. I spoke to the nurse and got brief history and gave orders . I told her to do chest X- ray and a blood test to check on congestive heart failure and give couple of medicines and call me is she was not better in 1 hour . I also told her that I will see her at 5 pm , which was 2 hours from the call.

    I went see her at 5 pm I looked at the chart to see as to what was happening . I saw the chest X- ray. and I saw the blood reports and then went to see the patient. There were family members and the nurse . She was little better . I told them that I felt that in my opinion she had episode of congestive heart failure and with new medicines she should improve in next 4-6 hours . I ordered medicines for the congestive heart failure and also for wheezing that she had . I did not get any call from the nurse after that . I went to see her next day and she was like new person . I readjusted her medicines . I reviewed the chart . She was seen by cardiologist , Infection specialist , blood doctor and hospital doctor . I did not see any mention of the things that happened yesterday in any of the notes other than hospital MD and the infection specialist , who had called me personally after he saw the patient .
If one would look at the cardiologist note only ,he would not know that she went in congestive heart failure.  There was no mention of the problem that she had , that was related to HEART .So 2 people seeing same patient , have very different view of the patient .