One major lesson I have learned is that the gap between academia/NIH and the real world of practice in large private health care organizations is so vast that it's almost hard to believe. Even though I have always had a significant clinical involvement, I was shocked at how little I understood about how the real world works. It's taken more than two years to figure out how it works, and very humbling. (Example: Hospitalist: Hi, haven't met you before, nice to meet you. I need some help with this patient with opioid addiction and pain. Me: Hi Dr. Jones, happy to help. Hospitalist: Have you been in this area for a long time? Me: I worked at the VA and the University for many years, then was at NIH for 5 years, then recently moved back here. Hospitalist: NIH? That's very nice. Now, can you help me get this patient out of the hospital?)
MW
MW
I was used to hearing those same comments. The only variation was: "Get this patient off of my service or out of my ER and onto your service." There were many more emotional variations of course but the bottom line is that: "I am concerned about my little part of the world and the patient is medically stable from my perspective." Medical stability also had wide variability and it doesn't hurt to keep the case managers focused on length of stay happy. I think it has gotten a lot worse as these decisions have less to do with medicine and become purely business decisions based on artificial ideas about the time that it requires to address complex problems or the amount of time that a person needs to be treated in a particular setting. In the "old" days - there was always academic interest among physicians in hospitals.
ReplyDeleteToday it is more like an assembly line.