Sunday, September 27, 2020


     The health care is changing for many years . We used to have family doctors and primary care doctors used to take care of the patients in offices and also in hospitals and also 'answered' to the questions  and treated minor element on phone after hours . But that all ended with HMO - the so called Health Care Maintenance organization that in my opinion decreased the quality of medical care  and also reduced income for many and most physicians  and made money for 3 piece suits - the so called management of theses HMO. Now the dust has settled on that change  and we have gotten used to the change  and have accepted the obstacles that ordinary physicians have to face due to rules and regulations -that are primarily meant for reducing cost and not helping any patients,-we are seeing another problem . This has been brought to surface more due to COVID. This is aging population. So that brings me to today's patients . 

     I was asked to see 2 different patients - happened to be in 2 rooms next to each other . One was 91 years old and other was 02 years old . Bothe of them were awake, alert and orientated . They both had a fall and that was not related to any black out spell or dizziness or anything unusual in the house. They both had rib fractures on right side. Fortunately they did not have much fluid or blood related to rib fractures  and had no puncture of the lung. They were admitted  and I saw them . They were pretty much with the program  and they were not in any respiratory distress. Their oxygen level was normal. So I spoke to the families and told them that we will watch them for a day or so and ask them to take deep breath and that will prevent collection of secretions  and then that can lead to pneumonia. The body does not do anything that causes pain and so with rib fracture of ribs, the patient automatically takes shallow breaths as deeper breaths will cause pain. But this shallow breathing and not coughing as coughing also causes pain , will lead to secretions not being cleared and then getting infected  and that causes pneumonia . So all that we as physicians do is to give pain medicines  and ask patients to take deep breaths every hour or so. So as per my plan they should be ready for discharge in 24- at the most 48 hours. 

     But as it happens the things don't work out as we like it to. The patients did well . The pain control was good  and the oxygen continued to be good breathing room air  and they did get out of bed and walked with physical therapy. So in my estimate they were ready for the discharge. But the problem was with the age. Both the families felt that they could not go to their prehospitalization level of living. They needed more physical therapy. So they had to be discharged to physical therapy unit. So now comes the COVID problem. We had to have COVID test done  and that has to ne negative . One family did not like one unit that was approved on her HMO insurance  and so we had to look for another one.So what could have been treated as out patient in younger patient, needed hospitalization. What I thought will be only 1 or 2 days became 5 days in one  and 6 days in other. 

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