Transferring a complicated patient 3 hours away

I handled the case presentation

With the addition of great complication

Planned down to the comma

This tale of drama

Ran a full minute’s narration.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. A winter in Nome, Alaska, assignments in rural Iowa, a summer with a bike tour in Michigan, and Urgent Care in suburban Pennsylvania stretched into the fall. Last winter found me working in western Nebraska and, later, in coastal Alaska.  After the birth of our first grandchild, I have returned to Nebraska. Any identifiable patient information has been included with permission.

On Friday a patient and I walked down the hallway. I said, “I write a blog.  Now I won’t write your gender, age, race or diagnosis, but I’d like to write that I took care of a very complicated, sick patient requiring lots of lab and x-ray and referral to a higher level of care than we can give you here.”

“Yeah, OK,” the patient said, and looked sideways at me.

I called the referral hospital, 3 hours away, and presented the case to the ER physician.

I do case presentations the way I used to do radio commercials in the early 70’s, during my college radio years at WYBC. If I can’t say it in less than 60 seconds, I need to reorganize.  This subgenre of the short story, when done well, presents human drama condensed down to the density of gold.  The very fact of doctor talking to doctor about a patient means that something important happened.  In a sense, it’s short play to a small audience.

I presented the story according to the conventional order: age, gender, race, presenting complaint, history of presenting illness, past medical history, social history, physical exam, lab, x-ray, EKG, and my working diagnosis, followed by the request, “Will you accept the transfer?”

“Yes,” the other doc said, “Of course. This is a very sick patient, but, I don’t quite understand, are you in the ER?”

No, I replied, I’m a locums. They send me the walk-ins.  Essentially, I’m doing Urgent Care, with benefits.

“You mean you did all THAT in Urgent Care?” she asked, flabbergasted.

I cared for 8 patients that day, the youngest 15, the oldest 95; 2 inpatients, 6 outpatients. I only wrote 3 new prescriptions but I stopped two others.

Though I used to look at a clinic day of 32 patients as nerve-wracking light, and 36 per day as perfect, I felt good when I left at 5:30. Learning a new EMR system takes weeks.

And towards the end of the day my ability to send prescriptions electronically directly to pharmacies suddenly stopped. While I saw the last patient, of course more complicated than anticipated, a team of 4 figured out that restoring that ability couldn’t happen, and set up my machinery to print prescriptions to be faxed.

But Bethany and I left the hospital behind, and drove to Denver, arriving after sunset, for a family gathering.



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