Case: My Life on the D-list

Today I worked up a 50-ish man who was admitted with altered mental status, cystitis and acute renal failure. He'd been in the hospital for just over twenty-four hours without much improvement. He wasn't hallucinating anymore, but restless, agitated, strange.

The previous hospitalist had ordered an abdominal/pelvic CT to investigate the patient's renal failure. A renal ultrasound was unremarkable, but the CT showed a markedly edematous left kidney with two obstructing kidney stones, the largest measuring 10mm. A kidney stone this size won't pass through the ureter on its own--at least there are no survivors of such a passage, to the best of my knowledge--so the patient needs to be seen by a urologist and undergo a cystoscopy with ureteral stenting.

Here in Rural, the urologists don't do procedures at my little hospital--affectionately known as Gimbels. All of their high-level urologic equipment is at the other local hospital, known as Macys. Over the four years I've been in Rural, the stance the urologists have taken has become more and more hostile towards Gimbels. Not only do they refuse to see patients at our hospital--"Send him to the ER at Macys and I'll deal with him there"--but they used to give me a lecture every time I got them on the phone. "Yeah, well Gimbels refuses to update their equipment, and if I'm going to flail, I want to flail with good equipment blah blah blah." I've heard this little speech from all three urologists, and it gets pretty stale after a while. I have been tempted to reply, "Enough with the foreplay, on to the main event!" Regrettably, I never have.

So I braced myself for the Wrath of Urology and called their office. I got a sweet-voiced receptionist.

"Our doctors don't take call for Gimbels," she said solemnly.

Now they've got their staff singing the aria. "I understand," I said stiffly. "This is a patient I'd like to transfer to Macys because I think he needs a cystoscopy."

"Oh. Can you hold?"

While on hold, I exchanged sour expressions with the house supervisor. We've both taken boatloads of attitude from the urologists.

The sweet-voiced receptionist returned. "Dr. Butthead says if you want to transfer the patient to Macys, you should call the hospital and arrange for the transfer and he'll talk to the hospitalist there." She said this very fast, as if anticipating howls of protest on my end.

"All right, thank you," I said in the lofty and overly-polite tone I reserve for moments when what I really want to say is: Damn you and all your ancestors.

So I deployed the considerable persuasive powers of our house supervisor, and after an only mildly unpleasant conversation with Macy's hospitalist, I faxed the patients information over and waited for the Great Ones to accept or refuse the transfer.

Next thing I knew, the nurses were running around in a flurry: "They've accepted the patient and want him in their OR in an hour!" Fifteen minutes of kerpuffle, and he was gone.

Think about this. Because the urologists are at war with Gimbels, they refuse to take my call. I bet you ten dollars Dr. Butthead thought my case was bullsh*t. But after seeing the CT report, he knew it was an urgent situation. God forbid he'd bother to talk to me, the doctor who was looking at the patient. He didn't even call me to say they wanted the patient in surgery right away. I still haven't heard from him, and if I do, I don't think I'll take the call.

Comments

[jayzee]

So I braced myself for the Wrath of Urology and called their office. I got a sweet-voiced receptionist.

"Our doctors don't take call for Gimbel's," she said solemnly.

Now they've got their staff singing the aria. "I understand," I said stiffly. "This is a patient I'd like to transfer to Macy's because I think he needs a cystoscopy: his CT shows two kidney stones, one of which measures 1cm, that's 10mm."

[bill]

You'd take the call, because thats the decent thing to do, which is the kind of person you are.

[dragonfly]

What KarenM said about hospital politics (and egos huffing and puffing about stupid things) getting in the way of patient care. Sigh.

[Karen Moeller]

Just from a patient standpoint, this is scary stuff. Hospital politics get in the way of appropriate patient care and the patient always is the one to take the brunt of it.

Thanks for exposing what happens all too frequently.

KarenM in NC

[emmy]

Here's the dish on this one. Dr. Attitude is a pain for you, but as a patient, I wouldn't want him for a doctor. If he's treating a collegue this way, how do you think he's treating his patients?

[IcedLatte]

One: God, if I have a 10mm stone in my ureter do not let me survive unless there is ample morphine available to gork me for at least a year. Two: I am going to damn the ancestors of everybody who irritates me today. That is a classically good line. Thank you much for sharing.