This morning I am up at the crack of dawn for the monthly quality assurance meeting. It is my favorite meeting of the month and I am not being facetious. I have been doing this for, let me see, almost sixteen years! There is more painless learning in this one hour than any other time of the month. The only time that it is painful is if one of my cases is being presented.
The physicians that serve on this committee receive no monetary compensation for what amounts to about six hours of work each month. The reward for serving on this committee is that a lot like medical school and residency, you find out what will get you in trouble second hand.
It works like this:
The hospital has a list of "quality indicators." Things such as excessive blood loss at a delivery or a surgery, the patient developing a complication, the baby developing a complication and so on. I believe you get the picture.
Now these things happen. And interestingly enough it is usually not the "quality indicator" that got the patient in trouble since everyone is doing everything they can to keep these things from happening.
No, what gets patients and ultimately doctors in trouble is some little, seemingly insignificant occurrence that no one noticed. Here too is the pay off for those of us on the committee.
I will give you an example. Early in my stint on this committee there was a Cesarean section patient who developed a fever. She received the correct antibiotic at delivery to protect her from infection. The doctor involved saw her when she developed the initial temperature spike and every spike after that for four days and then her appendix ruptured. She got peritonitis, an inflammation of the lining of the abdomen and had to undergo another surgery. This is when the appendicitis was diagnosed.
Now the chance of appendicitis after a C-section is probably less than one in a thousand patients but this whole thing happened to a very good physician that I respect a great deal. It also happens that I don't ever do a C-section without at least a glance at the appendix to make sure that it looks alright.
Every meeting is like that. Some great pearl of a pay off for those hours looking at charts, getting up early, wrestling with the issue of how to make the quality of medical care better for future patients.
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Musings of a physician in private practice for 24 years, now teaching in a residency program and working as an ob-gyn hospitalist in a large metropolitan hospital.
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The Local MD
Having now been a physician in private practice for twenty-one years, twenty-six days and about an hour and twenty minutes, it occurs to me that I have become what in medical school was often a derogatory term, the local MD.The presentation on rounds often went something like: "This 45 year old Caucasian male was seen last week by his LMD, and diagnosed with a viral upper respiratory infection..." At that point everyone knew that the LMD had missed the diagnosis. Otherwise the poor patient would not have ended up in a tertiary medical center with three consulting specialist, a fellow, a resident and four medical students at his bedside.What we, the medical students, the resident, the fellow and even the attending hospital physicians did not realize is that we would never know John Smith as well as the LMD. We would never speak to his wife using her first name. We would never be able to recall the names of all his children and know where they were in the world. We would never remember his favorite hobby let alone joke with him about it. Nor would we shed a heart felt tear when we gave him the diagnosis of the aggressive small cell carcinoma of the lung that had landed him in our midst and would kill him in less than three months despite our aggressive treatment that was the best medical science has to offer.At that point in my life I was very proud to be even the lowest ranking person on the team that was on the cutting edge of the diagnosis and the treatment of the gravest of conditions that plagued mankind. I felt so very lucky that I was being initiated in to this sacred fraternity. That I would soon be able to write "MD" after my name. I am still proud of my vocation yet I believe there is a wisdom that has only come with those twenty-years of practice.Today I realize what people want most of their physician is that he or she is someone who cares.Yes, we all want "everything medical science has to offer." Yet, what most of patients need is someone who will listen with their heart as well as with their head. Physician eyes are important, not only for seeing signs of disease in the body but for making contact with the patient's eyes where we are often allowed to see into their soul. All of the technology in the world will not replace a warm clasp of the hand or sitting at the bedside to share a few moments of the day along with the test results.So, I have created this blog. In large part it is a place for me to put my feelings. My hope is that at least some of these posts will resonate with others out there. Not just physicians, but others in caregiving vocations and even those for whom we care. If we are not here for each other then why are we here?
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