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Last week, I wrote about a 90-year-old guy with metastatic pancreatic cancer who received a million-dollar workup in the two days that he spent in the hospital. This week, we were reconsulted on an older guy with stroke-induced dementia who keeps getting sent to the emergency room from his nursing home because of recurrent urinary tract infections. Since April, he has had two CT scans of his chest, two abdominal ultrasounds, two scans of his gallbladder, three CT scans of his abdomen, and an MRI of his brain, and has had his bladder scoped. In addition, he's been seen by general surgery, gastroenterology, infectious disease, and neurology on each of his admissions.
Every time, he gets treated for his urinary infection and sent back to the nursing home.
The internist ordering all these exams and tests isn't making any money off it. She thinks she's simply being thorough, the patient's advocate.
This is a failure of our profession. Is it ever enough to tell a patient that there's nothing more to be done? Doctors feel the need to do, do, do, to intervene, to prescribe, to operate. All this scrambling around and following up on tests and procedures leaves little time for actual thought.
We've stopped thinking.
There isn't always a solution to a patient's sufferings, and we need to stop interpreting this unfortunate reality as a failure.
Visit Jeffrey Park's blog, ohiosurgery.blogspot.com
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