By Robert Dickman, M.D.
Imagine my surprise when I learned of my patient’s recent hospitalization at a major medical center in Boston. She was 86 years old and generally quite healthy. She had Atrial Fibrillation, a pacemaker, mild dizziness and a history of rectal bleeding which had been fully evaluated and attributed to hemorrhoids. After a self-limited episode of rectal bleeding her daughter panicked and called 911, despite normal vital signs and no symptoms she was of course transferred to a “downtown hospital.”
In the ED she was again hemodynamically stable but her monitor showed a heart rate in the 30’s. She felt fine but was nevertheless admitted for “observation” to a semi-private room. Her bed was by the window and the bathroom was by the door so she requested a private room for an extra fee. Her heart rate “came up” to the 70’s and it was determined that the monitor in the ED was defective! After about 36 hours, she was discharged with no change in her regimen.
I can only begin to imagine what this unnecessary sojourn cost Medicare and the patient herself! Had she called me directly I would have advised watchful waiting and a first morning appointment. The ED never bothered to call me where we could have at least discussed the case. Between the doctors in the ED, the hospitalists, and the specialists, finding a caregiver who actually knows the patient can be next to impossible.
Considering that nothing was actually done for her, The Four Seasons would have been cheaper option and the food would have been better.
Dr. Robert Dickman is the founding Jaharis Chair of Family Medicine at Tufts University School of Medicine.