Healthcare frustrations

30 Jul

I slept for ELEVEN hours last night.  For someone who normally gets 5-6 hours of sleep a night, that is a lot for me, and much needed!   I am someone who naturally functions well with relatively little sleep, but that’s only when I am waking up and going to bed at relatively the same time each day.  Once you throw in a mix of different work shifts, I get all thrown off.  When I am super tired, I still function ok at work because my attention is focused on one thing, but outside of work when I am doing multiple things at once, I am an absolute disaster.

Do you recall my post when I drove post call from Chicago to Detroit to visit my sister who had traveled there for work (Early onset dementia from working nights)??  Oh my goodness, first I couldn’t find the sponges I had just bought and later discovered that I had stored them away in the produce section of my fridge.  Then, I was 15 minutes out of the city when I realized I left my wallet at Starbucks.  Then, I was cursing at the toll collector on the highway, because it wouldn’t take my money, which I then realized was because Dean had an Ipass.  Ha.

Well, Saturday morning after my night shift, I had to pick up Dean at the airport.  We were on the phone and he was telling me where he was, and I couldn’t figure out why I couldn’t see him.   You know why??  I had driven to O’hare and his flight was to Midway.

Saturday night was my last night of this stretch of night shifts, and it was BUSY.  Friday and Saturday nights, particularly in the summer, can be very busy in the ER, and it can be extremely frustrating.  Why?  I don’t mind being busy, but it’s frustrating when it seems like a lot of people getting imaged after 1 am are trashed and here for stupid things they did because of their intoxication.  Do you know how much it costs to get a CT scan in the ER??  Ok, I don’t know the exact cause either, but it’s a lot.  Every weekend, many people get CT scans of their head and neck because of drunken falls.  The majority of them probably don’t need to get imaged, but there’s no way for the ER physicians to clear someone if the patient is so intoxicated and incoherent to make any sense.  People who are intoxicated have “altered mental status” which people with head injuries do too, so the ER physicians often have no choice but to scan them to make sure. To me at times, it feels like a waste of healthcare dollars and physicians’ time, because it can delay the time it takes for a physician to see and treat someone who is genuinely sick.  

You’ll have to forgive me for my venting and bitterness lately….working in the ER tends to make me bitter and hypercritical of society, and really, I swear I’m a caring person, it’s just that the stress and sleep deprivation can get to you….

There’s just two of us radiologists at the hospital at night, and we are responsible for reading every single piece of imaging that gets done at night through the ER.  Plus, we have to deal with any urgent imaging that gets done from any of the tons of patients already admitted at the hospital, some of which are obviously very very sick.  We also constantly get calls from CT or MRI techs regarding the appropriate imaging protocols before they scan an inpatient.

A lot of times, the ER’s ability to decide on treatment and their plan for a patient is affected by our diagnosis on the imaging they have ordered, so we have to try to read through the imaging studies the ER has ordered quickly so as to not back up the ER while still being thorough and not missing anything on the hundreds of images that are associated with each scan.  This is while at the same time having to constantly take calls from residents on the floor and pull up scans/images of their inpatients.

Added to the stress is when you are reading a CT scan of a patient with a potential surgical issue, because these cases are often life threatening and what you decide along with the surgical team may reflect whether the person is taken to the OR or not.

So can you see why it can be frustrating in a high stress environment when we’re trying to thoroughly and efficiently deal with genuinely sick patients with urgent matters to have to take time and deal with the stupid actions of intoxicated people?  Then there’s numerous other scans that get done that may not need to be ordered at that moment but get done anyway because of the litiginous environment we all have to work in today.  It’s easy for us in radiology to point fingers at the ER physicians and get annoyed at studies they ordered that may not seem necessary to us, but they have to work in a high volume ER with tons of patients they are seeing for the first time.  There’s hundreds of people they must evaluate, make decisions on, and treat quickly while at the back of their mind knowing they could get sued for any potential thing they miss.   If there is going to be health care reform, tort reform MUST be a part of it.  We as physicians are ALL affected by the fear of getting sued.  

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11 Responses to “Healthcare frustrations”

  1. Amd July 30, 2012 at 12:44 pm #

    I came across your blog, and often enjoy reading it. However, this post is a bit frustrating. For the most part, I agree with your point about drunks and the resources we waste in taking care of them.
    However, when you state “Thus, in the middle of the night, it is up to you and you only to make the call and decide whether that person goes to surgery or not. ” In reference to surgical patients, you are grossly incorrect. No surgeon EVERY makes a decision on taking a patient to the OR based on the radiology resident (or even attending) read. We (surgeons) read all films ourselves. We of course rely on radiology heavily for help with reading this films, but in the end it comes down to surgeons and surgeons alone on deciding if and when to take a patient to the OR, and the decision is much more complex than simply a CT read.

    • Julia July 30, 2012 at 12:49 pm #

      Very true. Your point is well taken and true. I will edit that. I have, however, had a surgical resident angry at us once when we called a closed loop obstruction and said, “do you realize that you are tying our hands behind our back to take her to the OR?”

      • Amd July 30, 2012 at 12:50 pm #

        Bad surgical resident :) Shouldn’t order the study if you are not going to listen to the results.
        Sorry if my response sounded like a rant, I didn’t intend for it to be that way.

      • Julia July 30, 2012 at 12:56 pm #

        no, no. Don’t apologize! I want to be called out if I misrepresent someone! And you are right, I made it sound like surgeons don’t think for themselves which is so far from the truth. In fact, to be honest, the surgery residents are my favorite ones to interact with in the middle of the night. I guess there’s just that occasional case where you feel like it’s all on your shoulders, but I guess we all feel like that at times regardless of our specialty. It’s part of learning how to become independent as physicians/residents.

      • Julia July 30, 2012 at 12:58 pm #

        I fixed up the wording a little bit, so I hope it sounds a little more accurate. I have total respect of you surgeons : )

      • Julia July 30, 2012 at 1:16 pm #

        Changed the wording around a third time : ) I often write when I am feeling passionate about something and don’t do much proofreading or editing.

  2. Julia July 30, 2012 at 1:08 pm #

    And please let me know if I misrepresent anyone else, since I can only fairly write from a radiology resident’s perspective.

    • Amd July 30, 2012 at 1:22 pm #

      I will! I really enjoyed/agreed with the AAA post. I think they should take it a bit farther. Smoking causes so many horrible things in addition to lung cancer. They should show teenagers wounds from PVD, what someone looks like with a trach from laryngeal cancer, etc. Then show them the amputees who have PVD mostly from smoking.

  3. Daphne @ Candy Coated Runner July 30, 2012 at 2:37 pm #

    Not being in the medical field, this is not something I ever thought about, so thanks for bringing it to light. I can’t imagine having to make those decisions.

  4. Losing Lindy August 1, 2012 at 6:16 am #

    First of all, I think it is so funny you were at the wrong airport. I am sure at the time, you were pretty frustrated.

    I think it is good that you come here and use this to vent. I can see your point. I need a place to vent about my job, but I am so scared that if it was found, I would lose my job. We have very different jobs, and I might be found “disgruntled” or something else just as bad.

    • Julia August 1, 2012 at 8:11 am #

      Yeah, you definitely have to be careful with what you write on a blog. I think with my situation, my frustrations aren’t targeted at a person or things specific to where I work, but are more targeted at our healthcare system as a whole.

      Yeah…pretty pathetic about the airport, huh? What’s even more funny is that when I finally made it to I-55, I started heading the wrong way on it!

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