Posts Tagged ‘chase the patient’

Food uncertainty: salmon and heart attack

November 14, 2012

Uncertainty comes with the call

If you’re hungry you might hit the wall

But a cardiac doc

Gave quite a talk

Then time slowed down to a crawl.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

As soon as I graduated med school I discovered that doctors never go hungry.   The doctors’ lounge in the hospital has pastries, fruit, and coffee in the morning and a lunch at noon.

Pharmaceutical manufacturers’ representatives, the drug detail force, line up to bring lunch and breakfast to outpatient clinics, in return asking for time to talk to the doctor.

As soon as I came to private practice, the dinner invitations started to roll in.  In 1987, the format included fine dining, a lecture, and a $100 check.  As regulations tightened, the out-and-out bribes stopped, replaced by “medically relevant” gifts; really good stuff useful for physical examination, like headlamps and otoscopes. 

Those gifts have gone, but the great meals continue in the century when I’m looking for opportunities to eat less and eat earlier.  I usually turn down the invites, especially if the lecturer comes from out-of-town.  But yesterday the chance to listen to a local cardiologist whom I trust and respect accompanied the chance to eat at one of Sioux City’s premier restaurants.  With call scheduled that night, I gave a tentative yes.

Clinic finished early with most of my documentation done.  I arrived before the appetizers. 

I enjoyed the lecture, I came to a better understanding of a beta blocker than few of my patients will be able to afford before it goes generic. 

But I paid the price of tension; call begets uncertainty and no one does their best work when hungry.  Eight PM came and went and the entrees had not arrived and my beeper went off.  The patient in the ER had classic findings of heart attack.  

A clinical summons always includes a time frame.  Flexibility ranges from drop everything to OK to wait till morning, depending on circumstances.  In this case the ER doctor had done all the right initial things, giving me a twenty-minute window.

I waited and the tension mounted.  Three minutes before I would have walked out without eating, my Scottish salmon with lotus root chip and black risotto arrived. 

I suppose it might have tasted good if I hadn’t bolted it, but bolt it I did and left, remembering how luxuriously wonderful cheese and crackers had tasted eaten at leisure on our Alaska road trip.

When I walked into the hospital I had the good sense to call ER first to find out the patient’s location.  After much dialogue I got a room number and I called the nurses’ station.  No such patient here now, they said.  I called back to the ER: nope, not here either; maybe X-ray; wait, please hold.  After a lot of hold, they told me the patient had just come back.  I went directly to ER.

Of course, I missed the patient who had been sent to an inpatient bed.  The nurses laughed, I didn’t.  When I finally got to the patient’s bedside, I had expended enough pursuit time that I could have eaten leisurely.

I had no way of knowing that beforehand.