Today marks the beginning of my third week as an inpatient at St. Joseph’s Hospital. You, the taxpayer, are paying about $1200 a day for my care. Ask yourself: are you getting your money’s worth?
Around 7:45 a.m. a complete stranger walks into my room and lays hands on me. I ask her what her name is and she tells me, adding that she is my bedside nurse for this shift. I propose that we observe some basic social amenities, such as introductions. We get through morning vital signs, then breakfast comes. Afterwards, I order the day’s meals.
The charge nurse comes in making her rounds. I request a new doctor. I am having drug reactions. The hospitalist currently attending me—for the past four days—does not believe that anyone can react to insulin. She has no alternate theory of the problem, has not ordered any tests to investigate it, has refused to discontinue the insulin order, and has refused to order consultations with any other specialists. My request to change doctors will be referred to the nursing floor manager. In this life, I often make requests that frontline workers have not previously encountered and have to refer up the line.
The bedside nurse comes back and we manage to get me cleaned up and ready for the day. My aide calls, asking what we’re doing today. I ask her to bring me Kleenex, two-ply toilet paper, help me with a shower, then take the dirty laundry home.
My Health Care Proxy checks in. I bring him up to date; we chat a few minutes, and then go on.
Dr. Ghaly arrives with a psychiatric resident in tow. I do believe Dr. Ghaly’s introduction of the new fellow indicated he might be coming into practice with Dr. Ghaly. This is seriously big news and indicative of a major change. The new guy is older than the average resident and has a history in the real world, including being a Certified Public Accountant—a useful background for a physician, particularly one working with Dr. Ghaly, who treated Medicaid patients for free for many years because he didn’t know psychiatric services could be billed to Medicaid.
I tell Dr. Ghaly that the St. Camillus home health care screener says that my chart says I have borderline personality. I do not. Dr. Ghaly—my psychiatrist for twenty years—did not put it there. It was picked up from somewhere else and put into my chart. For more on how psychiatric diagnoses are made, see http://behindthelockeddoors.wordpress.com/2011/02/24/how-i-got-diagnosed-with-unconscious-paranoid-schizophrenia/
The hospital is trying to build a major case that I am a nut job instead of addressing my physical illnesses. Three years ago I had psych testing that identified me as normal. I have not had any psychotherapy in two years. I have not been hospitalized for depression in seven years. Dr. Ghaly fights a never-ending battle to get his patients proper medical treatment. For more on that one, see http://behindthelockeddoors.wordpress.com/2011/03/27/cause-of-death-physician-prejudice/
Dr. Ghaly will write another big fat note in my chart, trying to refocus the medical staff on the medical problems. I tell him about the problem with the hospitalist, then I observe that my diabetes mellitus was well-controlled by diet for many years. Now, in about one year, my hemoglobin A1c has gone from 6.9 to 11.3: is my pancreas shutting down? The doctors look at each other but I move on to another consultation request, which was wrong. I should have stopped and let them deal with that issue.
But I go on to request a consultation with a nephrologist who is experienced in kidney transplantation. I figure on killing two birds with one stone. First, my research suggests that my kidney disease might be affecting my ability to tolerate medications. Second, if I am right that my immune system is reacting to aliens—in this case, medications—then the doctor who does transplants will have experience with immunosuppression issues. Since they haven’t got an immunologist on staff, we’ll go with the next best thing.
Dr. Ghaly agrees that this would be a good direction to go in investigating the problem, but explains the systemic hospital problem: he cannot order a consultation. Only the attending physician can—that would be the attending who I’m trying to fire for refusing to order consultations. Dr. Ghaly is a consult and he can’t order a consult. And the way the system works is that you request a consult with the day’s on-call nephrologist, not a nephrologist who does transplants. Dr. Ghaly goes off to work his expertise on the system and see what progress he can make. He will come back tomorrow.
I settle down to blog and then Kathy arrives at my bedside. She is a nurse-educator in the diabetes program. Her services were requested last week when I was taking insulin and hopeful of going home with it. After I had to stop taking the insulin because of the bad reaction, I asked the hospitalist to cancel the request for the diabetes educator. The doctor said she couldn’t. I asked a nurse to do the cancellation. She said she would, but here is Kathy at my bedside. How much time has she wasted coming to the floor, reviewing my chart, and talking to me? Are her services included in the $1200 you are paying for my care and treatment, or are her services billed separately? The hospital has 431 beds and 3600 employees. Which employee’s services are part of the package deal and which aren’t? Does anybody except me care how the charges are broken down?
The provision of care and the cost of care have become separated. The medical system will throw any and all kinds of nonsense at you without considering the cost. They don’t ask, “Is this, test/supply/medication really worth what it will cost?” They just say, well, let’s try it. The guys who consider the cost have no medical expertise and the guys who order the medical care have no accounting expertise. That’s another reason why you’re paying so much for Medicare and Medicaid.
N.B. Please note: St. Joseph’s Hospital considers the content of this post to be “malicious” and will not let their in-house staff or patients read it.