Another lament about why we need change

[Guest guest]

So I’m on my run today (nine miles) when my cell phone

goes off. I don’t really ever mind when patients call and this is a

patient who is somewhat distraught. She states, “I know I haven’t

seen you in a while, but we switched insurances and so we started going to

another physician. I tried to call the new doc, but was transferred to the

Ask-A-Nurse call center. After talking to the nurse, I was told to go to the ER

because I am having some atypical chest pain and she was concerned I was having

a heart attack and needed to be evaluated. My husband thinks I am not having a

heart attack and told me to call you—well, because you are always

available.”

Some background—patient is 35 years old, has 2 young

kids (the last with cleft lip), and has been seen over the past couple of years

for dizziness, palpitations, shortness of breath and the work-up has always

been normal. She states since she last saw me she has gained 15 pounds and has

a constant bloated feeling in her abdomen. Her husband is out of town over the

weekend. She complains of a sour taste in the back of her throat for the past

week or so and the pain resolves with Mylanta (which she took while I was on

the phone with her).

So here is my lament. In a 10 minute phone conversation

between mile 6 and 7, I have just saved a patient a $50 co-pay and 6-7 hours in

the ER, and I have saved her insurance about $1000 in unnecessary ER testing. Even

with the obvious poor access and poor continuity, she will see her doctor (who will

know nothing of any of this) early next week ensuring her doc gets paid. The

Ask-a-nurse program is funded through the hospital owned physician association

to which this doc belongs, so they get paid even for their wrong advice. But I

get zero except the satisfaction of a job well done.

Well, at least it gives me something to think about during

my long runs….